Provider Demographics
NPI:1609824556
Name:BRONK, JAMES B (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:BRONK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3222
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0293
Mailing Address - Country:US
Mailing Address - Phone:707-261-7804
Mailing Address - Fax:707-256-3508
Practice Address - Street 1:1200 B GALE WILSON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3552
Practice Address - Country:US
Practice Address - Phone:707-429-3600
Practice Address - Fax:707-429-7997
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG506122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
360003125OtherRAILROAD MEDICARE PIN
CA00G506120Medicaid
CA00G506120Medicaid
CA00G506120Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID
360003125OtherRAILROAD MEDICARE PIN