Healthcare Provider Details

I. General information

NPI: 1174744031
Provider Name (Legal Business Name): BRIAN A ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UNIVERSITY PKWY
PENSACOLA FL
32514-5752
US

IV. Provider business mailing address

PO BOX 17567
PENSACOLA FL
32522-7567
US

V. Phone/Fax

Practice location:
  • Phone: 850-208-6481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME141874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: