MEDICARE: DR. JAMES P ROUGLE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	11293	MT
2	2084P0800X	Psychiatry Physician	PT 12913	ND

General Provider Information

NPI Number	:	1881778181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES P ROUGLE DO

Provider Business Mailing Address
First Line	:	105 CHRISTOPHER CT
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-7581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 CHRISTOPHER CT
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-7581
Country	:	US
Telephone Number	:	406-755-6670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2013

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Directions to “ DR. JAMES P ROUGLE DO” Practice Location

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