Basic Information
| Provider Information | |||||||||
| NPI: | 1922056985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTTON | ||||||||
| FirstName: | CLIFFORD | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O., FACOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 BRANSON LANDING BLVD | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173488080 | ||||||||
| FaxNumber: | 4173357588 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 BRANSON LANDING BLVD | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173488080 | ||||||||
| FaxNumber: | 4173357588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R2E35 | MO | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1922056985 | 05 | MO | MEDICAID | 124513 | 01 | MO | BLUE CROSS | OTHER |