Roth, Gary F
Roth, Gary F is an sole proprietor health care provider with primary practice located at 2200 E Washington St , Bloomington IL 61701-4364. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Roth, Gary F can be contacted via phone (309) 661-5111.Contact Information
Primary practice address
2200 E Washington St
Bloomington IL 61701-4364
Phone: (309) 661-5111
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 036052934 | Illinois |
Profile Details
| NPI number | 1992732648 |
|---|---|
| LBN Legal business name | Roth, Gary F |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 27th, 2006 |
| Last updated | Sep 18th, 2009 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992732648 | NPPES |
| Illinois | MEDICAID | 036052934 |
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