Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 13744 | NV |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G27020 | CA |
NPI | 1043254907 |
---|---|
Provider Name | Dr. Ronald Carl Roth |
First Address | South Lake Tahoe, CA 96150-6207 |
Second Address | South Lake Tahoe, CA 95150-7059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 16/07/2014 |