Provider Demographics
NPI:1902885569
Name:SALES, JAMES A M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A M
Last Name:SALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5419
Mailing Address - Country:US
Mailing Address - Phone:309-786-0600
Mailing Address - Fax:309-786-8352
Practice Address - Street 1:2508 25TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5419
Practice Address - Country:US
Practice Address - Phone:309-786-0600
Practice Address - Fax:309-786-8352
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360972672084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097267Medicaid
IL036097267Medicaid
ILK09085Medicare PIN
P00606361Medicare PIN