Provider Demographics
NPI:1285696534
Name:NEVINS, JAMES PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PHILLIP
Last Name:NEVINS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 NORTH MAYFAIR ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2252
Mailing Address - Country:US
Mailing Address - Phone:414-727-7126
Mailing Address - Fax:414-607-3948
Practice Address - Street 1:27450 YNEZ ROAD
Practice Address - Street 2:SUITE 128
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4680
Practice Address - Country:US
Practice Address - Phone:951-693-2354
Practice Address - Fax:951-698-4434
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2010-10-12
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Provider Licenses
StateLicense IDTaxonomies
CAA26710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADJ718AMedicare PIN
CAA24929Medicare UPIN