Roth, Terry

Roth, Terry is an individual health care provider with primary practice located at 4920 East State St , Rockford IL 61108. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Roth, Terry can be contacted via phone (815) 226-1906.

Contact Information

Primary practice address
4920 East State St Rockford IL 61108
Phone: (815) 226-1906
Fax: (815) 226-8474
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 36059503 Illinois

Profile Details

NPI number 1215919816
LBN Legal business name Roth, Terry
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2005
Last updated May 22nd, 2008 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215919816 NPPES
Illinois Other 0010100550 BCBS
Illinois Other 791133579 BCBS
Illinois Other 009771 BCBS
Illinois MEDICAID 036059503 BCBS

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