Basic Information
| Provider Information | |||||||||
| NPI: | 1851396659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RORRER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8120 GARNET DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454582141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372721631 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3033 KETTERING BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372932133 | ||||||||
| FaxNumber: | 9372932161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 02/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34007087 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 03040 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0887136 | 01 | OH | MEDICARE ID-TYPE UNSPECIFIED | OTHER | 2142112 | 05 | OH | MEDICAID | 2245421 | 05 | OH | MEDICAID | 9358391 | 01 | OH | MEDICARE ID-TYPE UNSPECIFIED | OTHER |