Provider Demographics
NPI:1386620615
Name:JACK N ROTHMAN MD
Entity type:Organization
Organization Name:JACK N ROTHMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE PROPRIETORSHIP
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACOG
Authorized Official - Phone:727-734-6811
Mailing Address - Street 1:601 MAIN ST
Mailing Address - Street 2:STE 601
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5848
Mailing Address - Country:US
Mailing Address - Phone:727-734-6811
Mailing Address - Fax:727-736-2526
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:STE 601
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5848
Practice Address - Country:US
Practice Address - Phone:727-734-6811
Practice Address - Fax:727-736-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty