Provider Demographics
NPI:1144227778
Name:ROTH, JAMES M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:125 CRESTVIEW PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2850
Mailing Address - Country:US
Mailing Address - Phone:615-740-5233
Mailing Address - Fax:615-740-5226
Practice Address - Street 1:125 CRESTVIEW PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2853
Practice Address - Country:US
Practice Address - Phone:615-740-5233
Practice Address - Fax:615-740-5226
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN38445207YP0228X, 207YS0123X, 207YX0007X, 207YX0901X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4089622OtherBLUE CROSS AND BLUE SHIEL
TN7714168OtherCIGNA
TN0007459536OtherAETNA
TN3896879Medicaid
TNP00160344OtherMEDICARE RAILROAD
TN3896879Medicaid
TNI13816Medicare UPIN