MEDICARE: DR. LEON ROTH MD

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
1	207RC0000X	Cardiovascular Disease Physician	ME18438	FL

General Provider Information

NPI Number	:	1346399409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON ROTH MD

Provider Business Mailing Address
First Line	:	1460 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4617
Country	:	US
Telephone Number	:	954-455-2385
Fax Number	:	954-454-5994

Provider Business Practice Location Address
First Line	:	1460 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4617
Country	:	US
Telephone Number	:	954-455-2385
Fax Number	:	954-454-5994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/17/2014

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