Healthcare Provider Details

I. General information

NPI: 1386648350
Provider Name (Legal Business Name): GERALD ARTHUR ROSENBLUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 N CENTRAL AVE
PHOENIX AZ
85012-1521
US

IV. Provider business mailing address

6201 N 42ND ST
PARADISE VALLEY AZ
85253-3962
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-9111
  • Fax: 602-222-9333
Mailing address:
  • Phone: 602-380-2817
  • Fax: 602-224-5346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number10268
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: