Provider Demographics
NPI:1154345379
Name:FIERRO, JAMES (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FIERRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:FIERRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1805 FOULK RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3700
Mailing Address - Country:US
Mailing Address - Phone:302-529-2255
Mailing Address - Fax:302-529-2257
Practice Address - Street 1:1805 FOULK RD
Practice Address - Street 2:SUITE F
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3700
Practice Address - Country:US
Practice Address - Phone:302-529-2255
Practice Address - Fax:302-529-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0003345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000328203Medicaid
DEE87935Medicare UPIN
DEFI 675224Medicare ID - Type Unspecified