Provider Demographics
NPI:1679783385
Name:EWING, JAMES WALTER (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALTER
Last Name:EWING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 30TH ST #517
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3004
Mailing Address - Country:US
Mailing Address - Phone:619-295-5431
Mailing Address - Fax:619-291-3441
Practice Address - Street 1:3957 30TH ST # 517
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3004
Practice Address - Country:US
Practice Address - Phone:619-847-1018
Practice Address - Fax:619-291-3441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist