Healthcare Provider Details

I. General information

NPI: 1639217078
Provider Name (Legal Business Name): TIMOTHY AARON ROSFELD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E KIMBALL ST
CALLAWAY NE
68825-2589
US

IV. Provider business mailing address

211 E KIMBALL ST
CALLAWAY NE
68825-2589
US

V. Phone/Fax

Practice location:
  • Phone: 308-836-2228
  • Fax:
Mailing address:
  • Phone: 308-836-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number998
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: