Provider Demographics
NPI:1306843883
Name:ROTH, ROBERT STEPHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEPHAN
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2647 BOX CANYON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0450
Mailing Address - Country:US
Mailing Address - Phone:702-363-5575
Mailing Address - Fax:702-646-1727
Practice Address - Street 1:2647 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0450
Practice Address - Country:US
Practice Address - Phone:702-363-5575
Practice Address - Fax:702-646-1727
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV8797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8797OtherLICENSE #
NV8797OtherLICENSE #
NVF26510Medicare UPIN