Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4978 | WA |
Y | 213EG0000X | General Practice | 4978 | WA |
NPI | 1003859703 |
---|---|
Provider Name | Dr. Daniel Robert Roth |
First Address | Spokane, WA 99218-3803 |
Second Address | Spokane, WA 99218-3803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |