Basic Information
Provider Information | |||||||||
NPI: | 1912909227 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JAMES | ||||||||
FirstName: | MILTON | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4102 N ROXBORO ST | ||||||||
Address2: |   | ||||||||
City: | DURHAM | ||||||||
State: | NC | ||||||||
PostalCode: | 277042122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9195952000 | ||||||||
FaxNumber: | 9195952182 | ||||||||
Practice Location | |||||||||
Address1: | 4102 N ROXBORO ST | ||||||||
Address2: |   | ||||||||
City: | DURHAM | ||||||||
State: | NC | ||||||||
PostalCode: | 277042122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9195952000 | ||||||||
FaxNumber: | 9195952182 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2005 | ||||||||
LastUpdateDate: | 12/09/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 35077543 | OH | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   | 207W00000X | MD069803L | PA | N |   | Allopathic & Osteopathic Physicians | Ophthalmology |   | 207W00000X | 20115 | WV | N |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 0895377 | 01 | OH | MCR #OTHER TAX ID | OTHER | 6300115000 | 05 | WV |   | MEDICAID | 2150630 | 05 | OH |   | MEDICAID | 0017726390004 | 05 | PA |   | MEDICAID | P00336309 | 01 | OH | RRMCR # OTHER TAX ID | OTHER |