Provider Demographics
NPI:1063528602
Name:ROTHENBERG, ERIC SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SCOTT
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 E SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3959
Mailing Address - Country:US
Mailing Address - Phone:281-998-9000
Mailing Address - Fax:281-998-8001
Practice Address - Street 1:4500 E SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE 102
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3959
Practice Address - Country:US
Practice Address - Phone:281-998-9000
Practice Address - Fax:281-998-8001
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1029208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033734701Medicaid
TX033734701Medicaid
F21290Medicare UPIN