MEDICARE: ANTHONY ROSALES, DPM, PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0608	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AZ0195640	OTHER	AZ	BC/BS

General Provider Information

NPI Number	:	1952596991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY ROSALES, DPM, PC

Provider Business Mailing Address
First Line	:	421 N HUMPHREYS ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-4531
Country	:	US
Telephone Number	:	928-774-4825
Fax Number	:	888-464-1135

Provider Business Practice Location Address
First Line	:	421 N HUMPHREYS ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-4531
Country	:	US
Telephone Number	:	928-774-4825
Fax Number	:	888-464-1135

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY ROSALES
Credential	:	DPM
Telephone Number	:	928-774-4825

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	01/12/2011

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