Individual
DR. JAMES W PHOENIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1747 HENRY LUCKOW LN, BELVIDERE, IL 61008-1702
(815) 971-3030
(815) 971-9895
Mailing address
1747 HENRY LUCKOW LN, BELVIDERE, IL 61008-1702
(815) 971-3030
(815) 971-9895
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036059274
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059274
—
IL
01
—
F400205679
MEDICARE PTAN
IL
Enumeration date
01/30/2007
Last updated
06/18/2015
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