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NPI Code Detail

MEDICARE: DR. ROBERT STEPHAN ROTH M.D.

MEDICARE: DR. ROBERT STEPHAN ROTH M.D.
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
1207R00000XInternal Medicine Physician8797NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18797OTHERNVLICENSE #

General Provider Information

NPI Number : 1306843883
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT STEPHAN ROTH M.D.
Provider Business Mailing Address
First Line : 2647 BOX CANYON DRIVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0450
Country : US
Telephone Number : 702-363-5575
Fax Number : 702-646-1727
Provider Business Practice Location Address
First Line : 2647 BOX CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0450
Country : US
Telephone Number : 702-363-5575
Fax Number : 702-646-1727
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 08/31/2021

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