MEDICARE: JACOB ROTH

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	367500000X	Certified Registered Nurse Anesthetist	3316	MN

General Provider Information

NPI Number	:	1730036807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ROTH

Provider Business Mailing Address
First Line	:	120 QUAKER LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-6314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 PARK AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1829
Country	:	US
Telephone Number	:	612-873-3000
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/19/2026

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Directions to “ JACOB ROTH ” Practice Location

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