Provider Demographics
NPI:1548361900
Name:JAMES, DAVID NATHAN (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NATHAN
Last Name:JAMES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:DAVID
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:/USHY 491 NORTH
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420
Mailing Address - Country:US
Mailing Address - Phone:505-368-6814
Mailing Address - Fax:
Practice Address - Street 1:USHY 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60343479363A00000X, 363AM0700X
AZ3178363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S33575Medicare UPIN