Healthcare Provider Details

I. General information

NPI: 1770775033
Provider Name (Legal Business Name): STEVEN MICHAEL ROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 FILLINGIM ST
MOBILE AL
36617-2238
US

IV. Provider business mailing address

2451 FILLINGIM ST
MOBILE AL
36617-2238
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7891
  • Fax:
Mailing address:
  • Phone: 251-471-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.29036
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLT899
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.29036
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.29036
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: