Provider Demographics
NPI:1477080844
Name:ROHR, PAUL JUSTIN (NP-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JUSTIN
Last Name:ROHR
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 W TU AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-7616
Mailing Address - Country:US
Mailing Address - Phone:269-547-0272
Mailing Address - Fax:
Practice Address - Street 1:1717 SHAFFER ST STE 232
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1674
Practice Address - Country:US
Practice Address - Phone:269-226-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704255088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily