Individual
DR. WALTER E ROTH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
925 WILLISTON PARK PT, SUITE 1009, LAKE MARY, FL 32746-2114
(407) 323-2566
(407) 324-3577
Mailing address
925 WILLISTON PARK PT, SUITE 1009, LAKE MARY, FL 32746-2114
(407) 323-2566
(407) 324-3577
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO0001719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057893200
—
FL
01
—
480014891
RAILROAD MEDICARE
—
01
—
8316514011
CIGNA
—
Enumeration date
03/09/2006
Last updated
04/06/2024
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