Healthcare Provider Details

I. General information

NPI: 1508861121
Provider Name (Legal Business Name): ROBERT T ROTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MEASE DR SUITE 301
SAFETY HARBOR FL
34695-6602
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-724-2880
  • Fax: 727-333-6419
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME82877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: