Provider Demographics
NPI:1558944637
Name:PEARL FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:PEARL FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHGERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-600-3699
Mailing Address - Street 1:1445 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2226
Mailing Address - Country:US
Mailing Address - Phone:303-600-3699
Mailing Address - Fax:833-731-0601
Practice Address - Street 1:1445 S PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2226
Practice Address - Country:US
Practice Address - Phone:720-244-6993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty