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Individual

DR. NICOLE MEGAN ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPM

Contact information

Practice address
1400 28TH ST STE 2, BOULDER, CO 80303-1096
(303) 449-2000
(303) 449-9475
Mailing address
PO BOX 21150, BOULDER, CO 80308-4150
(303) 546-9158
(303) 546-9107

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD.0000829
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9000168464
CO
01
PO 3661
PODIATRIC MEDICAL LICENSE
FL
01
POD.0000829
LICENSE
CO
01
PR235
PODIATRIC RESIDENT
FL
Enumeration date
06/21/2011
Last updated
01/14/2019
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