Healthcare Provider Details

I. General information

NPI: 1366557928
Provider Name (Legal Business Name): JAMES B ROTH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

9722 E SIERRA AVE
CLOVIS CA
93619-9013
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-5491
  • Fax: 559-935-5719
Mailing address:
  • Phone: 559-935-5491
  • Fax: 559-935-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A4011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: