Individual
JOHN B ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3333 BARDSTOWN RD, LOUISVILLE, KY 40218-4613
(502) 452-6337
(502) 458-5327
Mailing address
PO BOX 950293, LOUISVILLE, KY 40295-0293
(888) 987-1875
(405) 609-1491
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
16654
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64166549
—
KY
Enumeration date
06/05/2006
Last updated
09/08/2016
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