| G&j Roth Prof Corp. | |
|
255 W Bullard Ave Ste 102 Clovis CA 93612-0861 | |
| (559) 299-2128 | |
| (559) 299-3494 |
| Full Name | G&j Roth Prof Corp. |
|---|---|
| Speciality | Family Medicine |
| Location | 255 W Bullard Ave Ste 102, Clovis, California |
| Authorized Official Name and Position | Timothy J Roth (OWNER/PHYSICIAN) |
| Authorized Official Contact | 5592992128 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| G&j Roth Prof Corp. 255 W Bullard Ave Ste 102 Clovis CA 93612-0861 Ph: (559) 299-2128 | G&j Roth Prof Corp. 255 W Bullard Ave Ste 102 Clovis CA 93612-0861 Ph: (559) 299-2128 |
| NPI Number | 1225250087 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 10/05/2010 |
| Medicare PECOS PAC ID | 2163519182 |
|---|---|
| Medicare Enrollment ID | O20071107000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225250087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Timothy J Roth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144213604 PECOS PAC ID: 2264469725 Enrollment ID: I20050726001011 |
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