Provider Demographics
NPI:1366415895
Name:SELF, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:SELF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:800 COMPASSION WAY
Mailing Address - Street 2:SUITE 136
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1956
Mailing Address - Country:US
Mailing Address - Phone:608-937-7000
Mailing Address - Fax:608-937-7001
Practice Address - Street 1:800 COMPASSION WAY
Practice Address - Street 2:SUITE 136
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1956
Practice Address - Country:US
Practice Address - Phone:608-937-7000
Practice Address - Fax:608-937-7001
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI34165-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31913000Medicaid
WIF26741Medicare UPIN
WI570850174Medicare PIN
WI31913000Medicaid