Provider Demographics
NPI:1366557928
Name:ROTH, JAMES B (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:ROTH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:9722 E SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9013
Mailing Address - Country:US
Mailing Address - Phone:559-935-5491
Mailing Address - Fax:559-935-5719
Practice Address - Street 1:2755 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6800
Practice Address - Country:US
Practice Address - Phone:559-935-5491
Practice Address - Fax:559-935-5719
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-02-04
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Provider Licenses
StateLicense IDTaxonomies
CA20A4011208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA349152400OtherUSDL
CA010000314OtherRAILROAD MEDICARE
CA00AX40110Medicaid
CA00AX40110Medicaid
CA010000314OtherRAILROAD MEDICARE