Provider Demographics
NPI:1053398107
Name:ENGBLOM, JAMES ARTHUR (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARTHUR
Last Name:ENGBLOM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6474
Mailing Address - Country:US
Mailing Address - Phone:865-481-2541
Mailing Address - Fax:865-483-8151
Practice Address - Street 1:90 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6474
Practice Address - Country:US
Practice Address - Phone:865-481-2541
Practice Address - Fax:865-483-8151
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM338213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN480026064OtherRAILROAD MEDICARE
TN3351783Medicaid
TN6035392OtherBCBS TN
TN6035392OtherBCBS TN
T97948Medicare UPIN
TN3351783Medicaid