Organization
HEART SHOP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS WAYNE ROTHROCK MD (OWNER)
(928) 708-9355
Entity
Organization
Contact information
Practice address
242 WHIPPLE ST, PRESCOTT, AZ 86301-1787
(928) 708-9355
(928) 778-0278
Mailing address
242 WHIPPLE ST, PRESCOTT, AZ 86301-1787
(928) 708-9355
(928) 778-0278
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Enumeration date
03/19/2020
Last updated
05/19/2020
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