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General NPI Number Information
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NPI Number | 1497795389
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Entity Type | Individual
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Provider Name | RONALD MATTHEW ROTH MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | PO BOX 1535
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City | PAROWAN
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State | UT
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Zip | 84761-1535
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Country | US
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Telephone | 702-218-5374
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1535
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City | PAROWAN
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State | UT
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Zip | 84761-1535
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Country | US
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Telephone | 702-218-5374
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5162
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5162
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 275830I205
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License Number State | UT
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