Bruce Alan Roth, D.O.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

3604 Issued in AZ

Practice address

18205 N 51St Ave
Suite 109
Glendale, AZ 85308-1490

Phone

(602) 547-1400

Fax

(602) 547-1401

NPI assigned

Jan 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Banner Thunderbird Medical Center

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1154355188
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1922087287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18205 N 51ST AVE",
            "address_2": "SUITE 109",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081490",
            "telephone_number": "602-547-1400",
            "fax_number": "602-547-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18205 N 51ST AVE",
            "address_2": "SUITE 109",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081490",
            "telephone_number": "602-547-1400",
            "fax_number": "602-547-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "BRUCE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "3604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590481",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "Z65448",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mason Ross, PA-C
• Alfred C Rossum, MD
• Carla Jean Rotering, MD
• Barbara J. Roth
• Brandon Ian Roth, M.D.
• Earl Eugene Roth Jr., MD
• Daniela Rothenberg
• Samantha Rothman
• Charles Rounds, PAC
• Dominike Rounds

• Anesthesiology Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Anesthesiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.