MEDICARE: EDWARD E ROTAN MD INC

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	207Q00000X	Family Medicine Physician	36877	AZ

General Provider Information

NPI Number	:	1922267905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD E ROTAN MD INC

Provider Business Mailing Address
First Line	:	PO BOX 710
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-4602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 MCCULLOCH
Second Line	:	SUITE 102
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9998
Country	:	US
Telephone Number	:	951-809-3746
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD EARL ROTAN JR.
Credential	:	MD
Telephone Number	:	951-809-3746

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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