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General NPI Number Information
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NPI Number | 1730128083
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Entity Type | Individual
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Provider Name | JOHN B ROTH MD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 3333 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-4613
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Country | US
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Telephone | 502-452-6337
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Fax | 502-458-5327
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Provider Business Mailing Address
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Address Line | PO BOX 950293
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City | LOUISVILLE
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State | KY
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Zip | 40295-0293
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Country | US
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Telephone | 888-987-1875
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Fax | 405-609-1491
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 16654
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License Number State | KY
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