Provider Demographics
NPI:1801902846
Name:ROTH, WILLIAM I (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:I
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 29306207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD 63408Medicare UPIN
95307Medicare ID - Type Unspecified