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Individual

LINCOLN R ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
200 BUNKER HILL DR, AITKIN, MN 56431-1865
(218) 927-5522
Mailing address
200 BUNKER HILL DR, AITKIN, MN 56431-1865
(218) 927-5522

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R030067
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0585463
IA
01
415T5RO
MN BLUE CROSS BS
MN
05
460224743-48
NE
01
4995584
BLUE CROSS OF SD
SD
05
5754210
SD
05
5754214
SD
05
871418500
MN
Enumeration date
07/11/2006
Last updated
10/01/2014
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