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General NPI Number Information
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NPI Number | 1154383982
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Entity Type | Individual
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Provider Name | JAMES JOSEPH NORCONK JR. MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 7 SAILFISH RD
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City | VERO BEACH
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State | FL
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Zip | 32960-5279
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Country | US
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Telephone | 208-415-0524
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Fax | 208-763-3644
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Provider Business Mailing Address
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Address Line | 601 FRONT AVENUE SUITE #502
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City | COEUR D ALENE
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State | ID
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Zip | 83814
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Country | US
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Telephone | 208-415-0524
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Fax | 208-763-3644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M9157
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License Number State | ID
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