Provider Demographics
NPI:1376567586
Name:GROTH, JAMES NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NORMAN
Last Name:GROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2201 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2328
Mailing Address - Country:US
Mailing Address - Phone:760-901-5060
Mailing Address - Fax:760-754-2612
Practice Address - Street 1:2201 MISSION AVE # 115
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2328
Practice Address - Country:US
Practice Address - Phone:760-901-5060
Practice Address - Fax:760-754-2612
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G605660Medicaid
CA00G605660Medicaid
CAA53604Medicare UPIN