Individual
JOHN B. ROTH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
107 W JEFFERSON ST, MORRIS, IL 60450-2128
(815) 942-0683
Mailing address
107 W JEFFERSON ST, MORRIS, IL 60450-2128
(815) 942-0683
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
036044899
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036044899
—
IL
Enumeration date
01/29/2007
Last updated
09/21/2011
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