MEDICARE: JEFFREY JOSEPH ROTH MD

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	208200000X	Plastic Surgery Physician	7663	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932109212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY JOSEPH ROTH MD

Provider Business Mailing Address
First Line	:	6140 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6737
Country	:	US
Telephone Number	:	702-450-0777
Fax Number	:	702-459-7701

Provider Business Practice Location Address
First Line	:	6140 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6737
Country	:	US
Telephone Number	:	702-450-0777
Fax Number	:	702-459-7701

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/05/2022

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