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General NPI Number Information
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NPI Number | 1104911486
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Entity Type | Individual
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Provider Name | MICHAEL E ROTH DPM
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 1901 BABCOCK RD STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4544
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Country | US
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Telephone | 210-872-3668
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Fax | 210-428-6317
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Provider Business Mailing Address
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Address Line | 94 BRIGGS ST STE 600
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City | SAN ANTONIO
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State | TX
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Zip | 78224-1272
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Country | US
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Telephone | 210-872-3668
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Fax | 210-428-6317
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1272
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License Number State | TX
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