MEDICARE: TRISTAN COOPER-ROTH 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	2085R0202X	Diagnostic Radiology Physician	009861	AZ

General Provider Information

NPI Number	:	1134794761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN COOPER-ROTH DO

Provider Business Mailing Address
First Line	:	1501 N. CAMPBELL AVE.
Second Line	:	PO BOX 245067
City	:	TUCSON
State	:	AZ
Zip	:	85724
Country	:	US
Telephone Number	:	520-694-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 NORTH CAMPBELL AVENUE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719
Country	:	US
Telephone Number	:	520-694-0111
Fax Number	:

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	03/02/2026

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Directions to “ TRISTAN COOPER-ROTH DO” Practice Location

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