Provider Demographics
NPI:1063625044
Name:JAMES M. ROACH M.D.
Entity type:Organization
Organization Name:JAMES M. ROACH M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-353-3190
Mailing Address - Street 1:1600 S. IMPERIAL AVENUE #6
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:760-353-3190
Mailing Address - Fax:
Practice Address - Street 1:1600 S. IMPERIAL AVENUE #6
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-353-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty