Provider Demographics
NPI:1053001073
Name:ROATH, COLTON MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:MICHAEL
Last Name:ROATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650859 DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BOULEVARD
Practice Address - Street 2:5.504 JENNIE SEALY HOSPITAL
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0877
Practice Address - Country:US
Practice Address - Phone:409-266-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program