| Doctor Name: | JAMES R ENNIS |
| NPI Number: | 1881666865 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | R6639 |
| Business Practice Address: | 180 Northstar Holts Summit, MO - 65043 |
| Business Phone Number: | 5738965115 |
| Business Fax Number: | 5738964272 |
| Mailing Address: | 180 Northstar, Capital Region Medical Clinic HOLTS SUMMIT |
| State: | MO |
| Postal Code: | 65043 |
| Phone Number: | 5738965115 |
| Fax Number: | 5738964272 |
| NPI Enumeration Date: | 02/03/2006 |
| NPI Last Update Date: | 07/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | R6639 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |