Healthcare Provider Details

I. General information

NPI: 1699974089
Provider Name (Legal Business Name): COREY P ROTHROCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E 23RD ST
SIOUX FALLS SD
57105-2135
US

IV. Provider business mailing address

810 E 23RD ST
SIOUX FALLS SD
57105-2135
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5890
  • Fax: 605-336-3974
Mailing address:
  • Phone: 605-331-5890
  • Fax: 605-336-3974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number239510-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: