Individual
BRADLEY J ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
G84133
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G841330
INDIVIDUAL BLUE SHIELD
CA
05
—
00G841330
—
CA
01
—
00G841330C29
CAL OPTIMA
CA
01
—
020048518
MEDICARE RAILROAD
CA
Enumeration date
07/10/2006
Last updated
07/21/2015
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