Provider Demographics
NPI:1417048919
Name:ROTELLA, JAMES T (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:ROTELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-4822
Mailing Address - Country:US
Mailing Address - Phone:352-589-1335
Mailing Address - Fax:352-589-1336
Practice Address - Street 1:629 S GROVE ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4822
Practice Address - Country:US
Practice Address - Phone:352-589-1335
Practice Address - Fax:352-589-1336
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1193213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5678940001Medicare NSC
FLT55486Medicare UPIN
FL87467ZMedicare PIN