Individual
BRIAN DOUGLAS ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13317 SE POWELL BLVD, PORTLAND, OR 97236-3335
(503) 763-9606
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200841450RN
OR
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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