Healthcare Provider Details

I. General information

NPI: 1629489067
Provider Name (Legal Business Name): DAVID MICHAEL ROTHROCK D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 10/31/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

6060 N CENTRAL EXPY STE 600
DALLAS TX
75206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-3555
  • Fax: 210-702-4239
Mailing address:
  • Phone: 615-665-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR3421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: