Provider Demographics
NPI:1093077307
Name:ROTHBERG, PHILIP ANDREW (MD, MPH&TM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW
Last Name:ROTHBERG
Suffix:
Gender:M
Credentials:MD, MPH&TM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:300 SAINT ELIZABETH WAY STE 230
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-1153
Practice Address - Country:US
Practice Address - Phone:904-389-8861
Practice Address - Fax:904-396-4893
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101254601208600000X
FLME148056208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery