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General NPI Number Information
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NPI Number | 1851323950
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Entity Type | Individual
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Provider Name | ANGELA RUTH ROTH M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2315 8TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-7301
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Country | US
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Telephone | 208-746-1383
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Fax | 208-746-1383
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Provider Business Mailing Address
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Address Line | 2315 8TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-7301
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Country | US
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Telephone | 208-746-1383
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Fax | 208-746-1383
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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 | M-13774
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License Number State | ID
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