MEDICARE: MR. JAMES LEA ALI P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2928	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588635643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES LEA ALI P.A.-C

Provider Business Mailing Address
First Line	:	3306 W ROOSEVELT ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-3404
Country	:	US
Telephone Number	:	602-278-4930
Fax Number	:	602-269-7772

Provider Business Practice Location Address
First Line	:	3306 W ROOSEVELT ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-3404
Country	:	US
Telephone Number	:	602-278-4930
Fax Number	:	602-269-7772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	04/08/2011

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