Basic Information
| Provider Information | |||||||||
| NPI: | 1124119698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTHMAN | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3338 | ||||||||
| Address2: | |||||||||
| City: | TOHAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870263338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082307 | ||||||||
| FaxNumber: | 5059082310 | ||||||||
| Practice Location | |||||||||
| Address1: | 4710 JEFFERSON ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871092155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057804040 | ||||||||
| FaxNumber: | 5058889644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A-1176-01 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004A81 | 01 | NM | BCBS FOR 850164038 | OTHER | 85725064 | 05 | NM | MEDICAID | 004A55 | 01 | NM | BCBS | OTHER |