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Individual

DR. BRANDON IAN ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
18555 N 79TH AVE STE D101, GLENDALE, AZ 85308-6040
(480) 563-6400
(480) 563-8009
Mailing address
PO BOX 6408, SCOTTSDALE, AZ 85261-6408
(480) 563-6400
(480) 563-8009

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
60636
AZ
208VP0014X
Interventional Pain Medicine Physician
Primary
60636
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
007126
AZ
Enumeration date
05/06/2015
Last updated
04/27/2021
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