Provider Demographics
NPI:1013987932
Name:ROE, JAMES R (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:ROE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMH REGIONAL MEDICAL CENTER
Mailing Address - Street 2:630 EAST RIVER ST.
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-329-7500
Mailing Address - Fax:
Practice Address - Street 1:EMH REGIONAL MEDICAL CENTER
Practice Address - Street 2:630 EAST RIVER ST.
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-329-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001995363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00350758OtherRAILROAD MEDICARE
PA78091Medicare PIN
OHQ22935Medicare UPIN
P00350758OtherRAILROAD MEDICARE