Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | TR00046791 | WA |
Y | 2080P0205X | Pediatric Endocrinologist | TR00046791 | WA |
NPI | 1073606174 |
---|---|
Provider Name | Christian L Roth |
First Address | Seattle, WA 98105-1010 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 03/02/2009 |