Individual
DELFORD MARK ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
416 VALLEY VIEW DR, SUITE 301, SCOTTSBLUFF, NE 69361-1486
(308) 633-9021
(308) 633-9023
Mailing address
416 VALLEY VIEW DR, SUITE 301, SCOTTSBLUFF, NE 69361-1486
(308) 633-9021
(308) 633-9023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
491
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
491
STATE LICENSE NUMBER
NE
Enumeration date
10/04/2006
Last updated
12/11/2007
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