Organization
JEFFREY A ROTHER, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY A ROTHER MD (OWNER)
(580) 224-2900
Entity
Organization
Contact information
Practice address
1221 G ST NW, ARDMORE, OK 73401-1812
(580) 224-2900
(580) 224-0009
Mailing address
1221 G ST NW, ARDMORE, OK 73401-1812
(580) 224-2900
(580) 224-0009
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
17679
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17679
OK LICENSE #
OK
01
—
1811951999
TAX ID #
OK
01
—
442605098-002
BCBS 12 DIGIT #
OK
Enumeration date
08/29/2006
Last updated
08/22/2020
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