Provider Demographics
NPI:1902808884
Name:ROSENBERG, ROBERT S (DO, FCCP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 N WINDSONG DR
Mailing Address - Street 2:STE A
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1222
Mailing Address - Country:US
Mailing Address - Phone:928-772-6422
Mailing Address - Fax:928-772-6425
Practice Address - Street 1:3259 N WINDSONG DR
Practice Address - Street 2:STE A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1222
Practice Address - Country:US
Practice Address - Phone:928-772-6422
Practice Address - Fax:928-772-6425
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1893207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00201903OtherRAILROAD MEDICARE
AZ290002146OtherRAILROAD MEDICARE
AZP00201903OtherRAILROAD MEDICARE
AZZ107121Medicare PIN
AZZWCJCW03Medicare PIN
AZZ102486Medicare PIN