Provider Demographics
NPI:1235309535
Name:WILLIAM I ROTH MD PA
Entity Type:Organization
Organization Name:WILLIAM I ROTH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-731-4900
Mailing Address - Street 1:10075 JOG RD STE 206
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3536
Mailing Address - Country:US
Mailing Address - Phone:561-731-4900
Mailing Address - Fax:561-731-4419
Practice Address - Street 1:10075 JOG RD STE 206
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3536
Practice Address - Country:US
Practice Address - Phone:561-731-4900
Practice Address - Fax:561-731-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty