Individual
MARK BRYAN ROTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BC-HIS
Contact information
Practice address
12751 COUNTY ROAD 5, SUITE 198, BURNSVILLE, MN 55337-2263
(952) 808-9079
(952) 882-9190
Mailing address
12751 COUNTY ROAD 5, SUITE 198, BURNSVILLE, MN 55337-2263
(952) 808-9079
(952) 882-9190
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2287
MN
Other
Enumeration date
01/19/2009
Last updated
01/19/2009
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