Provider Demographics
NPI:1154358828
Name:LEA, JAMES Y (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Y
Last Name:LEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2022 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3541
Mailing Address - Country:US
Mailing Address - Phone:208-667-5536
Mailing Address - Fax:208-765-1194
Practice Address - Street 1:2022 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3541
Practice Address - Country:US
Practice Address - Phone:208-667-5536
Practice Address - Fax:208-765-1194
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM44762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002582500Medicaid
ID1115602Medicare ID - Type Unspecified
ID002582500Medicaid