MEDICARE: LISA ROTHGERY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	TL-1877	CO
2	207Q00000X	Family Medicine Physician	DR.0046058	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780730317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ROTHGERY MD

Provider Business Mailing Address
First Line	:	300 S JACKSON ST
Second Line	:	SUITE 340
City	:	DENVER
State	:	CO
Zip	:	80209-3176
Country	:	US
Telephone Number	:	303-316-0416
Fax Number	:	303-316-0421

Provider Business Practice Location Address
First Line	:	300 S JACKSON ST
Second Line	:	SUITE 340
City	:	DENVER
State	:	CO
Zip	:	80209-3176
Country	:	US
Telephone Number	:	303-316-0416
Fax Number	:	303-316-0421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	02/05/2016

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Directions to “ LISA ROTHGERY MD” Practice Location

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