Provider Demographics
NPI:1316040611
Name:ROTHWELL, IAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:H
Last Name:ROTHWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:SUITE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-246-9080
Mailing Address - Fax:602-246-9105
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:SUITE
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2437
Practice Address - Country:US
Practice Address - Phone:602-246-9080
Practice Address - Fax:602-246-9105
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ208703Medicaid
AZD00211Medicare UPIN