Individual
DR. BRIAN P. ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1022 W IVY AVE, MOSES LAKE, WA 98837-4107
(509) 765-7845
(509) 765-5192
Mailing address
1022 W IVY AVE, MOSES LAKE, WA 98837-4107
(509) 765-7845
(509) 765-5192
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD00029599
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7729007
—
WA
Enumeration date
05/23/2005
Last updated
08/18/2010
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