Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD07336 | OR |
Y | 208600000X | Surgeon | MD07336 | OR |
NPI | 1003832619 |
---|---|
Provider Name | Dr. Roger Stuart Bothwell |
First Address | Roseburg, OR 97470-5552 |
Second Address | Roseburg, OR 97470-6523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |