Individual
DR. JUSTIN STEPHAN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3399 E LOUISE DR STE 200, MERIDIAN, ID 83642-5212
(208) 706-2663
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
187405
OR
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
O-1847
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
187405
OREGON MEDICAL BOARD
OR
05
—
500746847
—
OR
Enumeration date
06/19/2012
Last updated
07/28/2023
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