Provider Demographics
NPI:1215923370
Name:ROTHROCK, CHRISTOPHER R (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:ROTHROCK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-514-3500
Mailing Address - Fax:314-878-7678
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:DEPT ORTHOPAEDIC SURGERY, STE 230
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6282
Practice Address - Country:US
Practice Address - Phone:314-514-3500
Practice Address - Fax:314-878-7678
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003010405207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200146468Medicaid
H84609Medicare UPIN