Provider Demographics
NPI:1528368156
Name:ERIC S. ROTHENBERG, M.D., P.A
Entity Type:Organization
Organization Name:ERIC S. ROTHENBERG, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:281-422-5547
Mailing Address - Street 1:4201 GARTH RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-422-5547
Mailing Address - Fax:281-422-5990
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:SUITE 111
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-422-5547
Practice Address - Fax:281-422-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1029261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty