Provider Demographics
NPI:1457331621
Name:ROAT, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ROAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 HAMILTON BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2910 HAMILTON BLVD
Practice Address - Street 2:STE 103
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2423
Practice Address - Country:US
Practice Address - Phone:712-252-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23838207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA208371Medicaid
NE20520OtherNEBRASKA BLUE SHIELD
A002980OtherTRICARE
CAXPY047960Medicaid
WA1073972Medicaid
MT75985Medicaid
CO2984768Medicaid
NE42-123915400Medicaid
SD7775360Medicaid
WA1073972Medicaid
MT75985Medicaid