| Doctor Name: | MRS. MARY DEBORAH ROTH |
| NPI Number: | 1467606392 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D.L.D |
| License Number: | 2001016361 |
| Business Practice Address: | 3009 N Ballas Rd Ste 216b Ste 216b Saint Louis, MO - 631312322 |
| Business Phone Number: | 3149964351 |
| Business Fax Number: | 3149964591 |
| Mailing Address: | 3009 N Ballas Rd Ste 216b, Ste 216b SAINT LOUIS |
| State: | MO |
| Postal Code: | 631312322 |
| Phone Number: | 3149964351 |
| Fax Number: | 3149964591 |
| NPI Enumeration Date: | 11/05/2008 |
| NPI Last Update Date: | 11/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 2001016361 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |