Provider Demographics
NPI:1598796724
Name:ROTATORI, DONALD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SCOTT
Last Name:ROTATORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:SCOTT
Other - Last Name:ROTATORI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 W MORSE BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3797
Mailing Address - Country:US
Mailing Address - Phone:407-628-5476
Mailing Address - Fax:407-628-4108
Practice Address - Street 1:800 W MORSE BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3797
Practice Address - Country:US
Practice Address - Phone:407-628-5476
Practice Address - Fax:407-628-4108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18796OtherBLUECROSSBLUE SHIELD
FL18796OtherBLUECROSSBLUE SHIELD
K9233Medicare ID - Type Unspecified
FL18796OtherBLUECROSSBLUE SHIELD