Healthcare Provider Details

I. General information

NPI: 1508034471
Provider Name (Legal Business Name): RONALD ROSEDALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12635 E MONTVIEW BLVD STE 131
AURORA CO
80045-7335
US

IV. Provider business mailing address

12635 E MONTVIEW BLVD STE 131
AURORA CO
80045-7335
US

V. Phone/Fax

Practice location:
  • Phone: 720-859-4132
  • Fax:
Mailing address:
  • Phone: 720-859-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number36003
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: