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Individual
DR. NICOLE MEGAN ROTH
Active
Individual
DR. NICOLE MEGAN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD.0000829
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000168464
—
CO
01
—
PO 3661
PODIATRIC MEDICAL LICENSE
FL
01
—
POD.0000829
LICENSE
CO
01
—
PR235
PODIATRIC RESIDENT
FL
Enumeration date
06/21/2011
Last updated
01/14/2019
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