Individual
DR. ILAN JOSE ROTHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 NW 14TH AVE, STE 300, PORTLAND, OR 97209-2643
(503) 299-9906
(503) 225-9002
Mailing address
PO BOX 2040, PORTLAND, OR 97208-2040
(503) 299-9906
(503) 225-9002
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD28510
OR
390200000X
Student in an Organized Health Care Education/Training Program
LL17378
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025298
—
OR
05
—
8524738
—
WA
01
—
P00695329
RR MEDICARE
OR
Enumeration date
07/26/2007
Last updated
09/17/2009
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