Joe M Roundtree, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

12278 Issued in OK

Practice address

104 NW 31St
Lawton, OK 73505

Phone

(580) 536-2121

Fax

(580) 536-2150

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1962596148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6130",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73506",
            "telephone_number": "580-536-2121",
            "fax_number": "580-536-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 NW 31ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73505",
            "telephone_number": "580-536-2121",
            "fax_number": "580-536-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUNDTREE",
        "first_name": "JOE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OK",
            "license": "12278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "020003594",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "37D0686457",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100123090A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harlan L Ross Jr., LADC U/S
• Howard K Ross, OD
• Leland Ja-Rel Ollen Ross
• Ruth M Ross, PT
• Adrianne Candace Roughface
• Jessica D Roupe, RBT
• Michael Roy Rousseau, CM
• Phoenix M Rousseau
• Terri Michele Rowe, COTA/L
• Nivian Rozumialski

• Dermatology Physician in Lawton, OK
• Providers in Lawton, OK by specialty
• Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.