Healthcare Provider Details

I. General information

NPI: 1114910015
Provider Name (Legal Business Name): RICHARD J ROSENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W COUNTY LINE RD SUITE 110
HIGHLANDS RANCH CO
80129-2318
US

IV. Provider business mailing address

206 W COUNTY LINE RD SUITE 110
HIGHLANDS RANCH CO
80129-2318
US

V. Phone/Fax

Practice location:
  • Phone: 303-791-9999
  • Fax: 303-791-2778
Mailing address:
  • Phone: 303-791-9999
  • Fax: 303-791-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21131
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01211317
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: