MEDICARE: TOWER PULMONARY ASSOCIATES A MED GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A29402	CA
2	207R00000X	Internal Medicine Physician	G24071	CA
3	207R00000X	Internal Medicine Physician	G32106	CA

General Provider Information

NPI Number	:	1073548681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWER PULMONARY ASSOCIATES A MED GROUP

Provider Business Mailing Address
First Line	:	1400 S GRAND AVE STE 605
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3068
Country	:	US
Telephone Number	:	213-742-0910
Fax Number	:	213-742-6631

Provider Business Practice Location Address
First Line	:	1400 S GRAND AVE STE 605
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3068
Country	:	US
Telephone Number	:	213-742-0910
Fax Number	:	213-742-6631

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT K. ROTHBART
Credential	:	MD
Telephone Number	:	213-742-0910

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	04/30/2015

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