Individual
DR. FRED W ROTTNEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1402 S GRAND BLVD, FAMILY AND COMMUNITY MEDICINE, SAINT LOUIS, MO 63104-1004
(314) 977-8489
Mailing address
1402 S GRAND BLVD, FAMILY AND COMMUNITY MEDICINE, SAINT LOUIS, MO 63104-1004
(314) 977-8489
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
108515
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204968416
—
MO
Enumeration date
12/14/2005
Last updated
07/16/2015
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