MEDICARE: DR. JOHN ROSEGRANT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3841	AZ

General Provider Information

NPI Number	:	1093017733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ROSEGRANT PH.D.

Provider Business Mailing Address
First Line	:	4031 E SUNRISE DR
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85718-4342
Country	:	US
Telephone Number	:	520-529-2402
Fax Number	:

Provider Business Practice Location Address
First Line	:	4031 E SUNRISE DR
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85718-4342
Country	:	US
Telephone Number	:	520-529-2402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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Directions to “ DR. JOHN ROSEGRANT PH.D.” Practice Location

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