Roth, Brandon Ian

Roth, Brandon Ian is an individual health care provider with primary practice located at 18555 N 79Th Ave Ste D101 , Glendale AZ 85308-6040. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Pain Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Roth, Brandon Ian can be contacted via phone (480) 563-6400.

Contact Information

Primary practice address
18555 N 79Th Ave Ste D101 Glendale AZ 85308-6040
Phone: (480) 563-6400
Fax: (480) 563-8009
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 60636 Arizona
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 60636 Arizona

Profile Details

NPI number 1568849990
LBN Legal business name Roth, Brandon Ian
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 6th, 2015
Last updated Apr 27th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568849990 NPPES
Arizona MEDICAID 007126

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