James R Debord

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

JAMES R DEBORD

Practice address

5409 N Knoxville Ave
Peoria, IL 61614-5016

Phone

(877) 852-4669

NPI assigned

Aug 3, 2006

Last updated

Jun 1, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Debord, M.D.

Title

President

Phone

(877) 852-4669

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Vascular Laboratory Services Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1699783886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10140",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616120140",
            "telephone_number": "877-852-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5409 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145016",
            "telephone_number": "877-852-4669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES R DEBORD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "DEBORD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "877-852-4669",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "07200604",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360520633",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "330001311",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vascular Laboratory Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ahmed Tejan Jalloh Jr., MD
• Lynne Marie Jalovec, M.D.
• James J Malavolti DC LLC (Malavolti Chiropractic Center)
• James K Crane MDSC
• James L. Swingler M.D. Gynecology & Obstetrics S.C.
• Colleen James, OTR/L
• Gordon W James, MD
• Laura E James, APN
• Maryelizabeth Tyler James, M.D.
• Adeel Jamil, M.D

• Vascular Surgery Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Vascular Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.