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NPI Code Detail

MEDICARE: GERALD B. ROTH DO

MEDICARE: GERALD B. ROTH DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2224AZ

General Provider Information

NPI Number : 1255490322
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALD B. ROTH DO
Provider Business Mailing Address
First Line : 5055 E BROADWAY BLVD STE A100
Second Line :
City : TUCSON
State : AZ
Zip : 85711-3629
Country : US
Telephone Number : 520-327-0460
Fax Number : 520-795-0225
Provider Business Practice Location Address
First Line : 6236 E PIMA ST STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85712-3164
Country : US
Telephone Number : 520-327-6874
Fax Number : 520-327-0028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 11/08/2021

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Directions to “ GERALD B. ROTH DO” Practice Location

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