| Doctor Name: | MR. TERRY L. ROTH |
| NPI Number: | 1083878508 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 28182642A |
| Business Practice Address: | 304 E Quail Wood Ln Westfield, IN - 460749038 |
| Business Phone Number: | 3178673318 |
| Business Fax Number: | |
| Mailing Address: | 304 E Quail Wood Ln, WESTFIELD |
| State: | IN |
| Postal Code: | 460749038 |
| Phone Number: | 3178673318 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2008 |
| NPI Last Update Date: | 02/05/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0200X |
| License Number: | 28182642A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Critical Care Medicine |
| Taxonomy Definition: | |