Provider Demographics
NPI:1578683041
Name:ROTTER, ARTHUR THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:THOMAS
Last Name:ROTTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14410 SANDHURST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5958
Mailing Address - Country:US
Mailing Address - Phone:352-428-3121
Mailing Address - Fax:
Practice Address - Street 1:14410 SANDHURST ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5958
Practice Address - Country:US
Practice Address - Phone:352-428-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003794363AS0400X
FLPA9104151363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003498600Medicaid
FLY9Q6OtherBCBS
NY6210L1Medicare ID - Type Unspecified
FLAE373YMedicare PIN
NYQ68550Medicare UPIN