Healthcare Provider Details

I. General information

NPI: 1790362176
Provider Name (Legal Business Name): JOHN ALEXANDER ROSASCO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 RIVERBEND DR
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

PO BOX 7247
SPRINGFIELD OR
97475-0011
US

V. Phone/Fax

Practice location:
  • Phone: 541-684-5124
  • Fax:
Mailing address:
  • Phone: 541-681-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number226028
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: