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General NPI Number Information
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NPI Number | 1164689519
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Entity Type | Individual
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Provider Name | DARREN J ROTH PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 8990 WASHINGTON ST
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City | THORNTON
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State | CO
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Zip | 80229-4537
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Country | US
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Telephone | 303-665-3036
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 801106
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City | KANSAS CITY
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State | MO
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Zip | 64180-1106
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Country | US
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Telephone | 800-953-0104
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Fax | 303-765-6670
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA.0002769
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0002769
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License Number State | CO
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