Provider Demographics
NPI:1497838858
Name:ROOT, DAVID E (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:ROOT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 POWER INN RD
Mailing Address - Street 2:STE. 130
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-6753
Mailing Address - Country:US
Mailing Address - Phone:916-387-8252
Mailing Address - Fax:916-387-6977
Practice Address - Street 1:5501 POWER INN RD
Practice Address - Street 2:STE. 130
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-6753
Practice Address - Country:US
Practice Address - Phone:916-387-8252
Practice Address - Fax:916-387-6977
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 271632083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33291Medicare UPIN