Individual
PHILIP ANTHONY ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2089 CECIL ASHBURN DR SE, SUITE 101, HUNTSVILLE, AL 35802-2567
(256) 533-3966
(256) 882-9757
Mailing address
420 LOWELL DR SE, SUITE 103, HUNTSVILLE, AL 35801-3754
(256) 535-5940
(256) 882-9757
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12141
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000085204
—
AL
01
—
0004036975
AETNA
—
01
—
080055438
RAILROAD MEDICARE
—
01
—
51085204
BLUE CROSS BLUE SHIELD
AL
Enumeration date
11/09/2005
Last updated
08/21/2012
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