Provider Demographics
NPI:1194875120
Name:ROTH, HENRY JULES (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JULES
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 S CLARKSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1628
Mailing Address - Country:US
Mailing Address - Phone:303-698-2600
Mailing Address - Fax:303-698-2693
Practice Address - Street 1:1221 S CLARKSON ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1628
Practice Address - Country:US
Practice Address - Phone:303-698-2600
Practice Address - Fax:303-698-2693
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21066208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78261MPIESMedicare ID - Type Unspecified
COD23871Medicare UPIN