Individual
DR. ROBERT ERIC ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2333 KNOB CREEK RD, SUITE 11, JOHNSON CITY, TN 37604-2007
(423) 952-0500
(423) 952-0005
Mailing address
2333 KNOB CREEK RD, SUITE 11, JOHNSON CITY, TN 37604-2007
(423) 952-0500
(423) 952-0005
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2177
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3689027
—
TN
01
—
4037912
BCBS - BEHAVIORAL HEALTH
TN
01
—
4076590
BCBS - MEDICAL
TN
01
—
TN0101
JOHN DEERE
TN
Enumeration date
09/29/2005
Last updated
07/08/2007
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