Provider Demographics
NPI:1912989823
Name:ROTMENSCH, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:ROTMENSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5877
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5877
Mailing Address - Country:US
Mailing Address - Phone:623-845-0137
Mailing Address - Fax:623-209-9805
Practice Address - Street 1:8410 W THOMAS RD
Practice Address - Street 2:BLDG 4, SUITE 138
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3329
Practice Address - Country:US
Practice Address - Phone:623-845-0137
Practice Address - Fax:623-209-9805
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ32594207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBR1523491OtherDEA
AZA59358Medicare UPIN