Provider Demographics
NPI:1063730505
Name:JAMES, JAREMY EMER (DO)
Entity type:Individual
Prefix:
First Name:JAREMY
Middle Name:EMER
Last Name:JAMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 MATLOCK ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:817-473-7184
Mailing Address - Fax:817-473-7186
Practice Address - Street 1:252 MATLOCK ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-473-7184
Practice Address - Fax:817-473-7186
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB124675Medicare PIN
TXTXB110096Medicare PIN
TXP00947161OtherRAILROAD MEDICARE
TX8CL892OtherBCBS
TX216441001Medicaid
TX8CV878OtherBCBS
TX216441003Medicaid