| Doctor Name: | IVAR E ROTH |
| NPI Number: | 1013942606 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM, MPH |
| License Number: | E2628A |
| Business Practice Address: | 351 Hospital Rd Suite # 407 Newport Beach, CA - 926633509 |
| Business Phone Number: | 9496501147 |
| Business Fax Number: | 9496506434 |
| Mailing Address: | 351 Hospital Rd, Suite # 407 NEWPORT BEACH |
| State: | CA |
| Postal Code: | 926633509 |
| Phone Number: | 9496501147 |
| Fax Number: | 9496506434 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | E2628A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |