Provider Demographics
NPI:1376838698
Name:ROTTMAN, G JAY (MD)
Entity Type:Individual
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First Name:G JAY
Middle Name:
Last Name:ROTTMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:847 PARCHMENT SE
Mailing Address - Street 2:DMI CLINIC
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-940-1466
Mailing Address - Fax:616-940-3006
Practice Address - Street 1:847 PARCHMENT SE
Practice Address - Street 2:DMI CLINIC
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-940-1466
Practice Address - Fax:616-940-3006
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
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Provider Licenses
StateLicense IDTaxonomies
MI43010243242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology