Provider Demographics
NPI:1154383982
Name:NORCONK, JAMES JOSEPH JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:NORCONK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FRONT AVENUE
Mailing Address - Street 2:SUITE #502
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-415-0524
Mailing Address - Fax:208-763-3644
Practice Address - Street 1:7 SAILFISH RD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5279
Practice Address - Country:US
Practice Address - Phone:208-415-0524
Practice Address - Fax:208-763-3644
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM91572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3323275OtherMEDICARE 855R
KY64116346Medicaid
KY91721OtherSIHO KCR
KY3425604000OtherPASSPORT ADVANTAGE
VA3810010508OtherMEDICAID WV
VAP00403960OtherMEDICARE RAILROAD
VA010395224Medicaid
VA1154383982Medicaid
PA102079746Medicaid
PA2017776OtherHIGHMARK BS
KY000000548153OtherANTHEM
TX195976901Medicaid
KY50017550OtherPASSPORT KCR
TX195976901Medicaid
KY397024Medicare PIN
VA012546P27Medicare PIN
KY91721OtherSIHO KCR
VA1154383982Medicaid
PA121557-FLTMedicare PIN
VA013859C19Medicare PIN
ME000415601Medicare PIN
KY3323275OtherMEDICARE 855R
KY00011022Medicare PIN