Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 24953 | OK |
Y | 2086S0120X | Pediatric Surgery | K5393 | TX |
NPI | 1245333780 |
---|---|
Provider Name | Thomas A Rothenbach |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 20/04/2021 |