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General NPI Number Information
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NPI Number | 1083612444
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Entity Type | Individual
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Provider Name | ALAN I ROTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 5129 DIXIE HWY STE 105
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City | LOUISVILLE
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State | KY
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Zip | 40216-1729
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Country | US
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Telephone | 502-933-9902
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Fax | 502-933-5085
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Provider Business Mailing Address
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Address Line | PO BOX 6864
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City | LOUISVILLE
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State | KY
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Zip | 40206-0864
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Country | US
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Telephone | 502-933-9902
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Fax | 502-933-5085
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 21471
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License Number State | KY
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