Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | E5224 | TX |
NPI | 1427508027 |
---|---|
Provider Name | Dr. Bela Roth |
First Address | League City, TX 77573-5563 |
Second Address | League City, TX 77573-5563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2016 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OOAJ40 | BCBS (01) | TX |
POOOAJ406 | (05) | TX |