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Contact Information

TERRY ROTH
4920 EAST STATE ST
ROCKFORD, IL61108
 Phone: 815-226-1906
 Fax: 815-226-8474
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neurology

2084N0400X 13 Physician/Neurology
Indicates primary specialty

NPI Profile & details for TERRY ROTH · (Male)

NPI # 1215919816
Status Active
Credentials
Entity Individual
Enumeration date 11/18/2005
Last updated 05/22/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 36059503
  • IL Medicaid 036059503
  • IL Other 0010100550 BCBS
  • IL Other 009771 HEALTH ALLIANCE
  • IL Other 791133579 RETIRED RAILROAD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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