Provider Demographics
NPI:1831333517
Name:ROTH, FORREST SUSSMAN (MD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:SUSSMAN
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2800 KIRBY DR STE B212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1742
Mailing Address - Country:US
Mailing Address - Phone:713-559-9300
Mailing Address - Fax:888-878-1489
Practice Address - Street 1:2800 KIRBY DR STE B212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1742
Practice Address - Country:US
Practice Address - Phone:713-591-9283
Practice Address - Fax:888-878-1489
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery