Organization
PHILIP A. ROTH, JR., MD/PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP A. ROTH JR. M.D. (PRESIDENT)
(256) 533-3966
Entity
Organization
Contact information
Practice address
2089 CECIL ASHBURN DR SE, SUITE 101, HUNTSVILLE, AL 35802-2567
(256) 533-3966
(256) 533-9652
Mailing address
420 LOWELL DR SE, SUITE 103, HUNTSVILLE, AL 35801-3754
(256) 535-5940
(256) 535-5954
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12141
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000085204
—
AL
01
—
0004036975
AETNA
AL
01
—
080055438
RAILROAD MEDICARE
AL
01
—
510-85204
BLUE CROSS BLUE SHIELD
AL
Enumeration date
09/20/2010
Last updated
09/20/2010
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