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General NPI Number Information
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NPI Number | 1013105253
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Entity Type | Individual
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Provider Name | RONALD ROTH MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 1824 SALK AVE
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City | TAVARES
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State | FL
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Zip | 32778-4300
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Country | US
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Telephone | 352-253-0244
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Fax | 352-253-1175
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Provider Business Mailing Address
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Address Line | 1824 SALK AVE
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City | TAVARES
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State | FL
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Zip | 32778-4300
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Country | US
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Telephone | 352-253-0244
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Fax | 352-253-1175
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME34473
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License Number State | FL
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