Provider Demographics
NPI:1538293709
Name:DR. DAVID ROTHMAN PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. DAVID ROTHMAN PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-399-0616
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 352
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6795 E TENNESSEE AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1614
Practice Address - Country:US
Practice Address - Phone:303-399-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007134Medicaid