Individual provider · Type 1 NPI

Lucas B. Roth, PA-C

Surgical Physician Assistant · Peoria, IL

NPI number 1083124846 Active

Practice location

6000 N Allen Rd
Peoria, IL 61614-3294

Fax (309) 693-3197

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000X085006385 (IL)
Surgical Physician Assistant Primary 363AS0400X085006385 (IL)

Surgical Physician Assistant: Definition to come...

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About NPI 1083124846

Lucas B. Roth, PA-C's National Provider Identifier is 1083124846, issued on Oct 6, 2017. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Peoria, IL. The record was last updated on Jun 19, 2025.