Individual
TRAVIS ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1040 GULF BREEZE PKWY STE 204, GULF BREEZE, FL 32561-7808
(850) 916-8693
Mailing address
PO BOX 17567, PENSACOLA, FL 32522-7567
(850) 916-8423
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME143139
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106561400
—
FL
Enumeration date
06/17/2014
Last updated
11/09/2020
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