Provider Demographics
NPI:1023354107
Name:JAMES, MICHAEL WAYNE SR (INTERN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:JAMES
Suffix:SR
Gender:M
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 S WOOD DR
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6825
Mailing Address - Country:US
Mailing Address - Phone:918-756-9250
Mailing Address - Fax:918-756-9187
Practice Address - Street 1:1803 S WOOD DR
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6825
Practice Address - Country:US
Practice Address - Phone:918-756-9250
Practice Address - Fax:918-756-9187
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program