Provider Demographics
NPI:1467498824
Name:ROTHBERG, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:ROTHBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3820 TAMPA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3609
Mailing Address - Country:US
Mailing Address - Phone:727-785-6422
Mailing Address - Fax:727-785-9660
Practice Address - Street 1:3820 TAMPA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3609
Practice Address - Country:US
Practice Address - Phone:727-785-6422
Practice Address - Fax:727-785-9660
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME45342207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
62535ZMedicare PIN
D57489Medicare UPIN