Healthcare Provider Details

I. General information

NPI: 1740572833
Provider Name (Legal Business Name): ADAM PAUL ROTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY U109
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 51947
KNOXVILLE TN
37950-1947
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9220
  • Fax: 865-637-5518
Mailing address:
  • Phone: 865-588-0880
  • Fax: 865-584-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50778
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: