Individual
YURI C ROTHBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1400 E BOULDER ST, COLORADO SPRINGS, CO 80909
(719) 560-5656
(719) 560-4715
Mailing address
PO BOX 173891, DENVER, CO 80217-3891
(719) 365-5000
(719) 365-6827
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA.0001060
CO
363A00000X
Physician Assistant
Primary
PA.0001060
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1060
COLORADO LICENSE
CO
05
—
35288876
—
CO
01
—
P00065901
RAILROAD MEDICARE
—
Enumeration date
07/09/2006
Last updated
03/07/2023
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