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General NPI Number Information
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NPI Number | 1932347572
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Entity Type | Organization
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Legal Business Name | EDWARD J ROTMENSCH MD PLLC
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 8410 W THOMAS RD BLDG 4, SUITE 138
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City | PHOENIX
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State | AZ
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Zip | 85037-3329
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Country | US
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Telephone | 623-845-0137
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Fax | 623-209-9805
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Provider Business Mailing Address
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Address Line | PO BOX 5877
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City | PEORIA
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State | AZ
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Zip | 85385-5877
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Country | US
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Telephone | 623-845-0137
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Fax | 623-209-9805
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EDWARD JAMES ROTMENSCH
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Credential | MD PLLC
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Telephone | 623-845-0137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 32594
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License Number State | AZ
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