Provider Demographics
NPI:1285728527
Name:ROITH, JEFFREY T (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:ROITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:STE 360
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2379
Mailing Address - Country:US
Mailing Address - Phone:913-894-4040
Mailing Address - Fax:913-438-4725
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:STE 360
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2379
Practice Address - Country:US
Practice Address - Phone:913-894-4040
Practice Address - Fax:913-438-4725
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000626213E00000X
KS12-00235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16317091OtherBCBS KC
KS490218OtherBCBS
16317081OtherBCBS-KANSAS CITY
MO302968300Medicaid
KS6739140001Medicare NSC
16317091OtherBCBS KC
MO302968300Medicaid
A442128Medicare ID - Type UnspecifiedKANSAS CITY METRO AREA
KS6739140001Medicare NSC
16317081OtherBCBS-KANSAS CITY