Basic Information
| Provider Information | |||||||||
| NPI: | 1649387853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 CHIPPEWA DR | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545019503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153615480 | ||||||||
| FaxNumber: | 7153615499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1630 CHIPPEWA DR | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545019503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153615480 | ||||||||
| FaxNumber: | 7153615499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 12/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 40924 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 5101013329 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.