Provider Demographics
NPI:1194747691
Name:KLEIN, JAMES B (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:KLEIN
Suffix:
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 1:1601 N TUCSON BLVD
Mailing Address - Street 2:#28
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716
Mailing Address - Country:US
Mailing Address - Phone:520-795-9484
Mailing Address - Fax:
Practice Address - Street 1:1601 N TUCSON BLVD
Practice Address - Street 2:#28
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-795-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5352208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21753001Medicaid
AZ21753001Medicaid