Provider Demographics
NPI:1841249067
Name:ROTH, ROBIN FELICE (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:FELICE
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:ROTH
Other - Last Name:IVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1020 GOODLETTE-FRANK RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5449
Mailing Address - Country:US
Mailing Address - Phone:239-514-7100
Mailing Address - Fax:239-228-6732
Practice Address - Street 1:1020 GOODLETTE-FRANK RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5449
Practice Address - Country:US
Practice Address - Phone:239-514-7100
Practice Address - Fax:392-228-6732
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28666OtherBCBS
FLI40608Medicare UPIN