Healthcare Provider Details

I. General information

NPI: 1194875120
Provider Name (Legal Business Name): HENRY JULES ROTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S CLARKSON ST STE 300
DENVER CO
80210-1628
US

IV. Provider business mailing address

1221 S CLARKSON ST STE 300
DENVER CO
80210-1628
US

V. Phone/Fax

Practice location:
  • Phone: 303-698-2600
  • Fax: 303-698-2693
Mailing address:
  • Phone: 303-698-2600
  • Fax: 303-698-2693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number21066
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: