Provider Demographics
NPI:1124199989
Name:ROTH, WILLIAM T (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:T
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:212 E SANSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1348
Mailing Address - Country:US
Mailing Address - Phone:509-688-6702
Mailing Address - Fax:509-688-6792
Practice Address - Street 1:220 E ROWAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1203
Practice Address - Country:US
Practice Address - Phone:509-483-4403
Practice Address - Fax:509-489-7556
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00035230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802665OtherINDIVIDUAL MEDICARE PIN
WA8802665OtherINDIVIDUAL MEDICARE PIN