Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 072650 | GA |
N | 207RP1001X | Pulmonary Disease | 2008-01380 | NC |
NPI | 1023223260 |
---|---|
Provider Name | Craig Neale Rosebrock |
First Address | Dublin, GA 31021 |
Second Address | Canton, GA 30114-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
58866U | (02) | NC |