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General NPI Number Information
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NPI Number | 1831122068
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Entity Type | Individual
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Provider Name | YURI C ROTHBAUM PA
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909
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Country | US
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Telephone | 719-560-5656
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Fax | 719-560-4715
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Provider Business Mailing Address
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Address Line | PO BOX 173891
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City | DENVER
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State | CO
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Zip | 80217-3891
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Country | US
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Telephone | 719-365-5000
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Fax | 719-365-6827
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | PA.0001060
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0001060
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License Number State | CO
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