Provider Demographics
NPI:1912921321
Name:ROTH, JOHN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF KENTUCKY DEPARTMENT OF SURGERY
Mailing Address - Street 2:800 ROSE STREET, ROOM C225
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-6346
Mailing Address - Fax:859-323-6840
Practice Address - Street 1:UNIVERSITY OF KENTUCKY DEPARTMENT OF SURGERY
Practice Address - Street 2:800 ROSE STREET, ROOM C225
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-6346
Practice Address - Fax:859-323-6840
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036068Medicaid
MD2119996OtherMDIPA
MD240845OtherKAISER
MD1702116OtherUNITED HLTHCARE
MD1801005OtherUNITED HLTHCARE NATIONAL
MD84616OtherGEISINGER
KY30581OtherLICENSE
MD62757501OtherBLUE SHIELD
MD0090OtherCAREFIRST
MD403980700Medicaid
KY30581OtherLICENSE
MD62757501OtherBLUE SHIELD
MD2119996OtherMDIPA