Provider Demographics
NPI:1417929308
Name:ROTHWELL, DAVID T (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
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 1:9724 FARMHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:OK
Mailing Address - Zip Code:73007-9565
Mailing Address - Country:US
Mailing Address - Phone:405-203-3832
Mailing Address - Fax:877-463-3813
Practice Address - Street 1:700 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1212
Practice Address - Country:US
Practice Address - Phone:405-236-3131
Practice Address - Fax:405-239-7180
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100091760AMedicaid
OKP00276395OtherRAILROAD MEDICARE
OK241430306Medicare PIN
OK245505301Medicare PIN
OK100091760AMedicaid