Provider Demographics
NPI:1477637437
Name:ROTH, DAVID R (MD)
Entity Type:Individual
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First Name:DAVID
Middle Name:R
Last Name:ROTH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 GREENWAY PLZ
Mailing Address - Street 2:SUITE 910
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-822-3160
Practice Address - Fax:832-825-3159
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-03-01
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Provider Licenses
StateLicense IDTaxonomies
TXF57292088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136180004Medicaid
TXTXB117048Medicare PIN
C21343Medicare UPIN
80W621Medicare PIN