Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 38445 | TN |
N | 207YP0228X | Pediatric Otolaryngology | 38445 | TN |
N | 207YS0123X | Facial Plastic Surgeon | 38445 | TN |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 38445 | TN |
NPI | 1144227778 |
---|---|
Provider Name | Dr. James M Roth |
First Address | Dickson, TN 37055-2850 |
Second Address | Dickson, TN 37055-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 09/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007459536 | AETNA (01) | TN |
3896879 | (05) | TN |
4089622 | BLUE CROSS AND BLUE SHIEL (01) | TN |
7714168 | CIGNA (01) | TN |
I13816 | (02) | TN |
P00160344 | MEDICARE RAILROAD (01) | TN |