Healthcare Provider Details

I. General information

NPI: 1710372651
Provider Name (Legal Business Name): WILLIAM ROBERT LA ROSA III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 MILLER VALLEY RD
PRESCOTT AZ
86301-1813
US

IV. Provider business mailing address

PO BOX 5798
SCOTTSDALE AZ
85261-5798
US

V. Phone/Fax

Practice location:
  • Phone: 928-777-9600
  • Fax: 855-449-5560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56120
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: