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Organization
TOWER IMAGING MEDICAL GROUP, INC
Active
Organization
TOWER IMAGING MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD M. ROTH M.D. (PRESIDENT)
(323) 549-3030
Entity
Organization
Contact information
Practice address
2202 WILSHIRE BLVD, SANTA MONICA, CA 90403-5706
(310) 264-9000
(310) 264-9004
Mailing address
DEPT LA 21559, PASADENA, CA 91185-1559
(888) 727-1073
(866) 752-2240
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0056081
—
CA
05
—
GR0056083
—
CA
05
—
GR0056084
—
CA
05
—
GR0056085
—
CA
05
—
GR0056086
—
CA
01
—
ZZZ05808Z
BLUE SHIELD
CA
01
—
ZZZ07585Z
BLUE SHIELD
CA
01
—
ZZZ09295Z
BLUE SHIELD
CA
01
—
ZZZ59119Z
BLUE SHIELD
CA
01
—
ZZZ64302Z
BLUE SHIELD
CA
Enumeration date
05/24/2006
Last updated
02/09/2009
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