Healthcare Provider Details

I. General information

NPI: 1720421290
Provider Name (Legal Business Name): JOSHUA K ROUTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N 1ST ST STE 700
PHOENIX AZ
85004-2364
US

IV. Provider business mailing address

1 N 1ST ST STE 700
PHOENIX AZ
85004-2364
US

V. Phone/Fax

Practice location:
  • Phone: 602-481-9650
  • Fax: 602-610-4757
Mailing address:
  • Phone: 602-649-4498
  • Fax: 602-610-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD2017-0765
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number56886
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: