Healthcare Provider Details

I. General information

NPI: 1871655092
Provider Name (Legal Business Name): ROBERT J ROSENQUIST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W PLUMB LN SUITE 2A
RENO NV
89509-3666
US

IV. Provider business mailing address

540 W PLUMB LN SUITE 2A
RENO NV
89509-3666
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-1811
  • Fax: 775-348-7738
Mailing address:
  • Phone: 775-348-1811
  • Fax: 775-348-7738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number3981
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: