Individual
DR. ROBERT JAY ROTHBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
747 52ND STREET, PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION, OAKLAND, CA 94609
(510) 428-3058
(510) 450-5813
Mailing address
747 52ND STREET, PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION, OAKLAND, CA 94609
(510) 428-3058
(510) 450-5813
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R8845
MO
2080P0206X
Pediatric Gastroenterology Physician
Primary
G158847
CA
2080P0206X
Pediatric Gastroenterology Physician
R8845
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202032207
—
MO
05
—
ENROLLED
—
IL
Enumeration date
07/17/2006
Last updated
06/05/2019
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