Individual provider Active NPI

Thomas Franklin Roe, M.D.09

  • Specialist
  • Los Angeles, CA
National Provider Identifier
1124166392
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G8155 Issued in CA
Practice address
240 S Citrus Ave
Los Angeles, CA 90036-3038
Phone
(323) 934-1691
Fax
(323) 934-1691
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G8155 CA Primary

Addresses

Primary practice location

240 S Citrus Ave
Los Angeles, CA 90036-3038

Mailing address

240 S Citrus Ave
Los Angeles, CA 90036-3038
Phone (323) 934-1691

Other identifiers 1

IdentifierTypeStateIssuer
4394219MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
G8155CAMDSpecialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787529600000",
    "number": "1124166392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 S CITRUS AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363038",
            "telephone_number": "323-934-1691",
            "fax_number": "323-934-1691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 S CITRUS AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363038",
            "telephone_number": "323-934-1691",
            "fax_number": "323-934-1691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROE",
        "first_name": "THOMAS",
        "middle_name": "FRANKLIN",
        "name_prefix": "Dr.",
        "credential": "M.D.09",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G8155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4394219",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.