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General NPI Number Information
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NPI Number | 1609803477
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Entity Type | Individual
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Provider Name | JAMES H EXTINE DO
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 2516 BROADMOOR BLVD
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City | MONROE
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State | LA
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Zip | 71201-2988
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Country | US
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Telephone | 318-807-4746
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Fax | 318-812-6034
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Provider Business Mailing Address
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Address Line | 130 DESIARD ST STE 355
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City | MONROE
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State | LA
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Zip | 71201-7363
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Country | US
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Telephone | 318-807-7875
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Fax | 318-812-6603
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 071493
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | DO0000001192
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 307337
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License Number State | LA
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