Individual
GREGORY ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 9TH AVE, SEATTLE, WA 98104-2420
(206) 744-3475
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00045041
WA
207RC0000X
Cardiovascular Disease Physician
Primary
MD00045041
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0231763
L&I
WA
05
—
1922144146
—
WA
Enumeration date
01/29/2007
Last updated
08/06/2012
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