Healthcare Provider Details

I. General information

NPI: 1003905969
Provider Name (Legal Business Name): PAUL ALLEN ROSENBLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HARDING ROAD RUDY CANCER CENTER
NASHVILLE TN
37205-2005
US

IV. Provider business mailing address

PO BOX 440261
NASHVILLE TN
37244-0261
US

V. Phone/Fax

Practice location:
  • Phone: 615-222-6755
  • Fax: 615-222-3567
Mailing address:
  • Phone: 615-329-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD0000011643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: