Individual
JAMES H EXTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2516 BROADMOOR BLVD, MONROE, LA 71201-2988
(318) 807-4746
(318) 812-6034
Mailing address
130 DESIARD ST STE 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
071493
GA
207X00000X
Orthopaedic Surgery Physician
Primary
307337
LA
207X00000X
Orthopaedic Surgery Physician
DO0000001192
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1120944
CIGNA
TN
01
—
1170140002
PALMETTO GBA
TN
01
—
200037893
RAILROAD MEDICARE
TN
05
—
2462750
—
LA
01
—
3139316
BLUE CROSS BLUE SHIELD TN
TN
05
—
3304909
—
TN
01
—
373856800
OWCP
TN
01
—
TN0139
AMERICHOICE TENNCARE
TN
Enumeration date
06/27/2006
Last updated
06/11/2019
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