Provider Demographics
NPI:1992783609
Name:LAVIS, JAMES D (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:LAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3102
Mailing Address - Country:US
Mailing Address - Phone:609-602-7969
Mailing Address - Fax:
Practice Address - Street 1:2 E 14TH ST
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3102
Practice Address - Country:US
Practice Address - Phone:609-602-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03241600207VX0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1953800Medicaid
C52431Medicare UPIN
NJ1953800Medicaid