Provider Demographics
NPI:1962419887
Name:ROTHE, EUGENIO M (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:M
Last Name:ROTHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2199 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5232
Mailing Address - Country:US
Mailing Address - Phone:305-774-1699
Mailing Address - Fax:305-774-1674
Practice Address - Street 1:2199 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5232
Practice Address - Country:US
Practice Address - Phone:305-774-1699
Practice Address - Fax:305-774-1674
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME462522084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0641812-00Medicaid
FLD86523Medicare UPIN
FL0641812-00Medicaid