Provider Demographics
NPI:1952427809
Name:ROY A ROTHMAN DPM, PA
Entity Type:Organization
Organization Name:ROY A ROTHMAN DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-753-1918
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2059213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65145Medicare PIN
FL0935850001Medicare NSC
FLU02074Medicare UPIN