Provider Demographics
NPI:1609836600
Name:ROOK-ROTH, CATHERINE M (DO)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:ROOK-ROTH
Suffix:
Gender:F
Credentials:DO
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4374
Mailing Address - Fax:515-643-2784
Practice Address - Street 1:1350 DES MOINES ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5526
Practice Address - Country:US
Practice Address - Phone:515-643-0833
Practice Address - Fax:515-643-0933
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA149955Medicaid
IA990007005Medicare PIN
IA149955Medicaid
IA58638Medicare PIN