Healthcare Provider Details

I. General information

NPI: 1568456341
Provider Name (Legal Business Name): SHEPHERD F ROSENBLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DURALEIGH RD SUITE 100
RALEIGH NC
27612-8106
US

IV. Provider business mailing address

120 WILLIAM PENN PLZ
DURHAM NC
27704-2150
US

V. Phone/Fax

Practice location:
  • Phone: 919-788-8797
  • Fax: 919-788-8798
Mailing address:
  • Phone: 919-220-5255
  • Fax: 919-313-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9800374
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: