MEDICARE: ROBERT J ROSSER, MD, A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C0744491	OTHER	CA	CALIFORNIA CORPORATION

General Provider Information

NPI Number	:	1770544280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT J ROSSER, MD, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	11 MARK TER
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-2632
Country	:	US
Telephone Number	:	760-324-2780
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 N INDIAN CANYON DR
Second Line	:	DESERT REGIONAL MED CTR PATHOLOGY DEPT
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4872
Country	:	US
Telephone Number	:	760-323-6198
Fax Number	:	760-323-6195

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT J ROSSER
Credential	:	M.D.
Telephone Number	:	760-774-4604

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	07/11/2016

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