Doctor Name: | MARK BRYAN ROTHER |
NPI Number: | 1093952657 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BC-HIS |
License Number: | 2287 |
Business Practice Address: | 12751 County Road 5 Suite 198 Burnsville, MN - 553372263 |
Business Phone Number: | 9528089079 |
Business Fax Number: | 9528829190 |
Mailing Address: | 12751 County Road 5, Suite 198 BURNSVILLE |
State: | MN |
Postal Code: | 553372263 |
Phone Number: | 9528089079 |
Fax Number: | 9528829190 |
NPI Enumeration Date: | 01/19/2009 |
NPI Last Update Date: | 01/19/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 2287 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |