Individual
MRS. MARY DEBORAH ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.L.D
Contact information
Practice address
3009 N BALLAS RD STE 216B, STE 216B, SAINT LOUIS, MO 63131-2322
(314) 996-4351
(314) 996-4591
Mailing address
3009 N BALLAS RD STE 216B, STE 216B, SAINT LOUIS, MO 63131-2322
(314) 996-4351
(314) 996-4591
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2001016361
MO
Other
Enumeration date
11/05/2008
Last updated
11/05/2008
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