Provider Demographics
NPI:1053365395
Name:MANSOUR, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1610 W TOWNLINE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1066
Mailing Address - Country:US
Mailing Address - Phone:641-782-2131
Mailing Address - Fax:641-782-6425
Practice Address - Street 1:1610 W TOWNLINE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1066
Practice Address - Country:US
Practice Address - Phone:641-782-2131
Practice Address - Fax:641-782-6425
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA20578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080037613OtherRAILROAD MEDICARE NONBILL
IA1053365395Medicaid
IA080037613OtherRAILROAD MEDICARE NONBILL
IA1053365395Medicaid