Provider Demographics
NPI:1992758411
Name:TOOTHMAN, JAMES ROBERT (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:TOOTHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9218
Mailing Address - Country:US
Mailing Address - Phone:304-539-5557
Mailing Address - Fax:304-757-5557
Practice Address - Street 1:13 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9218
Practice Address - Country:US
Practice Address - Phone:304-539-5557
Practice Address - Fax:304-757-5557
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2024-11-08
Deactivation Date:2024-01-12
Deactivation Code:
Reactivation Date:2024-01-25
Provider Licenses
StateLicense IDTaxonomies
WV1441207R00000X, 146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110135471OtherRAILROAD MEDICARE
OH2047636Medicaid
WV000712231OtherBCBS INDIVIDUAL
WV0045606000Medicaid
WV023206600OtherFEDERAL BLACK LUNG
WV550737998OtherWV WORKERS COMP
OHTO4181881Medicare PIN
WV550737998OtherWV WORKERS COMP
WVT00815581Medicare PIN