Healthcare Provider Details

I. General information

NPI: 1598869687
Provider Name (Legal Business Name): MARK RICHARD ROSENBERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950N TATUM BLVD 350
PHOENIX AZ
85050-4256
US

IV. Provider business mailing address

2285 CORPORATE CIR STE 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 480-502-6651
  • Fax: 480-513-8253
Mailing address:
  • Phone: 702-360-2763
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: