Healthcare Provider Details

I. General information

NPI: 1992758411
Provider Name (Legal Business Name): JAMES ROBERT TOOTHMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date: 01/12/2024
Reactivation Date: 01/25/2024

III. Provider practice location address

13 EDGEWOOD DR
HURRICANE WV
25526-9218
US

IV. Provider business mailing address

13 EDGEWOOD DR
HURRICANE WV
25526-9218
US

V. Phone/Fax

Practice location:
  • Phone: 304-539-5557
  • Fax: 304-757-5557
Mailing address:
  • Phone: 304-539-5557
  • Fax: 304-757-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1441
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number1441
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: