Provider Demographics
NPI:1982636247
Name:ROTHBAUM, JEROME CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:CHARLES
Last Name:ROTHBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5240 E KNIGHT DR
Mailing Address - Street 2:SUITE #114
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2122
Mailing Address - Country:US
Mailing Address - Phone:520-318-9681
Mailing Address - Fax:520-325-6774
Practice Address - Street 1:5240 E KNIGHT DR
Practice Address - Street 2:SUITE #114
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2122
Practice Address - Country:US
Practice Address - Phone:520-318-9681
Practice Address - Fax:520-325-6774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4392207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00208Medicare UPIN