Provider Demographics
NPI:1922110154
Name:ROTHRAUFF, DONALD A (DPM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:ROTHRAUFF
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 1:620 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1704
Mailing Address - Country:US
Mailing Address - Phone:812-547-7482
Mailing Address - Fax:812-547-7482
Practice Address - Street 1:620 MAIN ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1704
Practice Address - Country:US
Practice Address - Phone:812-547-7482
Practice Address - Fax:812-547-7482
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000753213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN251470AMedicare PIN
U45581Medicare UPIN