James, Gordon W

James, Gordon W is an individual health care provider with primary practice located at 420 Ne Glen Oak Ave Ste 401 , Peoria IL 61603-3112. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. James, Gordon W can be contacted via phone (309) 676-8123.

Contact Information

Primary practice address
420 Ne Glen Oak Ave Ste 401 Peoria IL 61603-3112
Phone: (309) 676-8123
Fax: (309) 676-8455
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 036101714 Illinois

Profile Details

NPI number 1124158431
LBN Legal business name James, Gordon W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 6th, 2007
Last updated Sep 13th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124158431 NPPES
Illinois MEDICAID 036101714
Illinois Other 390006884

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