Individual
EARL EUGENE ROTH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5891 W EUGIE AVE, GLENDALE, AZ 85304-1252
(602) 588-6703
Mailing address
11001 N BLACK CANYON HWY, PHOENIX, AZ 85029-4757
(602) 371-2515
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
14021
AZ
208000000X
Pediatrics Physician
Primary
14021
AZ
208D00000X
General Practice Physician
14021
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
448424
—
AZ
Enumeration date
01/26/2006
Last updated
10/11/2007
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