MEDICARE: DR. MORTON ROTHBARD M.D. PH.D.

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	208800000X	Urology Physician	CFE25968	CA

General Provider Information

NPI Number	:	1932535648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORTON ROTHBARD M.D. PH.D.

Provider Business Mailing Address
First Line	:	4673 PINE VALLEY CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1878
Country	:	US
Telephone Number	:	209-495-0753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4673 PINE VALLEY CIR.
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219
Country	:	US
Telephone Number	:	209-495-0753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	02/22/2026

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