Basic Information
Provider Information
NPI: 1902870009
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WASHBURN
FirstName: JAMES
MiddleName: ALLEN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1010 THREE SPRINGS BLVD
Address2:  
City: DURANGO
State: CO
PostalCode: 813018296
CountryCode: US
TelephoneNumber: 9702474311
FaxNumber:  
Practice Location
Address1: 1010 THREE SPRINGS BLVD
Address2: STE 110
City: DURANGO
State: CO
PostalCode: 813018296
CountryCode: US
TelephoneNumber: 9707642750
FaxNumber: 9707642778
Other Information
ProviderEnumerationDate: 02/15/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X44253COY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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