Provider Demographics
NPI:1679550016
Name:ROTHMAN, ROY A (DPM)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 ENTERPRISE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-5210
Mailing Address - Country:US
Mailing Address - Phone:386-753-1918
Mailing Address - Fax:386-753-1902
Practice Address - Street 1:2836 ENTERPRISE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-5210
Practice Address - Country:US
Practice Address - Phone:386-753-1918
Practice Address - Fax:386-753-1902
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-2059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65145Medicare PIN
FLU02074Medicare UPIN
FL0935850001Medicare NSC