Provider Demographics
NPI:1205825916
Name:ROTHWELL, GARY H (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:H
Last Name:ROTHWELL
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 1:550 E STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5222
Mailing Address - Country:US
Mailing Address - Phone:407-381-7367
Mailing Address - Fax:407-331-6758
Practice Address - Street 1:550 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5222
Practice Address - Country:US
Practice Address - Phone:407-381-7367
Practice Address - Fax:407-331-6758
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64706Medicare UPIN
41460Medicare PIN