Individual
ROTH BUN EA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
635 ANDERSON RD STE 19, DAVIS, CA 95616-3505
(530) 758-1810
(530) 758-1896
Mailing address
635 ANDERSON RD STE 19, DAVIS, CA 95616-3505
(530) 758-1810
(530) 758-1896
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5893
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E5893
MEDICAL LICENSE
CA
Enumeration date
04/02/2017
Last updated
12/02/2022
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