Provider Demographics
NPI:1194805457
Name:PHELAN, JAMES TERENCE (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TERENCE
Last Name:PHELAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2429 W COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3124
Mailing Address - Country:US
Mailing Address - Phone:228-875-1141
Mailing Address - Fax:228-875-6885
Practice Address - Street 1:2429 W COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3124
Practice Address - Country:US
Practice Address - Phone:228-875-1141
Practice Address - Fax:228-875-6885
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80140213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118410Medicaid
MSU64129Medicare UPIN
MS00118410Medicaid