Individual
MICHAEL ROTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 N GRAHAM ST STE 580, PORTLAND, OR 97227-2003
(503) 528-0704
(503) 528-0808
Mailing address
300 N GRAHAM ST STE 125, PORTLAND, OR 97227-1683
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
166641
OR
363A00000X
Physician Assistant
Primary
PA166641
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500675638
—
OR
Enumeration date
03/23/2014
Last updated
11/12/2019
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