Healthcare Provider Details

I. General information

NPI: 1346577954
Provider Name (Legal Business Name): DARREN ROSSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 S 108TH ST
WEST ALLIS WI
53227-3519
US

IV. Provider business mailing address

2931 S 108TH ST
WEST ALLIS WI
53227-3519
US

V. Phone/Fax

Practice location:
  • Phone: 414-608-2475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number03-153
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3311
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: