Healthcare Provider Details

I. General information

NPI: 1669408258
Provider Name (Legal Business Name): REINHARD E. ROTT, MD, FACS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 W NORTHERN AVE
PHOENIX AZ
85021-5472
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number30464
License Number StateAZ

VIII. Authorized Official

Name: REINHARD ROTT
Title or Position: OWNER
Credential: MD
Phone: 602-395-0718