Individual
DR. DANIEL CHRISTOPHER ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MBA, MS
Contact information
Practice address
1721 MAGNAVOX WAY, FORT WAYNE, IN 46804-1537
(260) 748-3650
(260) 748-3651
Mailing address
PO BOX 670, HUNTERTOWN, IN 46748-0670
(260) 748-3650
(260) 748-3651
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
02003462A
IN
208100000X
Physical Medicine & Rehabilitation Physician
125050599
IL
208VP0014X
Interventional Pain Medicine Physician
02003462A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200938070
—
IN
01
—
790872
BCBS
IN
Enumeration date
09/12/2007
Last updated
02/04/2019
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