Provider Demographics
NPI:1588837157
Name:ROTHFORK, JACOB MELVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MELVILLE
Last Name:ROTHFORK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:159 ANYA RD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8582
Mailing Address - Country:US
Mailing Address - Phone:505-266-9963
Mailing Address - Fax:
Practice Address - Street 1:THE UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0124207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology