Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 017769 | ME |
NPI | 1083782916 |
---|---|
Provider Name | Dr. Elizabeth E Rothe |
First Address | Lewiston, ME 04240-7637 |
Second Address | Lewiston, ME 04240-7637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 09/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
433309399 | (05) | ME |