Provider Demographics
NPI:1730128109
Name:ROSEBROOK, JOSHUA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LEE
Last Name:ROSEBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:5950 UNIVERSITY AVE
Practice Address - Street 2:STE 145
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-875-9740
Practice Address - Fax:515-875-9672
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-373682085R0202X
KS04326342085R0202X
MA2164122085R0202X
IA373682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS865650OtherBCBS KS KS LOCATION
MO209915404Medicaid
P00454345OtherRR MEDICARE GROUP CK7871
KS865650OtherBCBS KS MO LOCATION
MO39183012OtherBCBS OF KANSAS CITY MO
KS200452880AMedicaid
KS106671Medicare PIN
KS865650OtherBCBS KS MO LOCATION