Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 28641 | GA |
N | 207R00000X | Internist | 28641 | GA |
N | 111NI0900X | Internist | 28641 | GA |
Y | 207RC0200X | Critical Care Medicine | 028641 | GA |
N | 207RC0200X | Critical Care Medicine | 2018-00697 | NC |
N | 207RP1001X | Pulmonary Disease | 028641 | GA |
N | 207RP1001X | Pulmonary Disease | 16450 | SC |
N | 207RP1001X | Pulmonary Disease | 2018-00697 | NC |
N | 207RP1001X | Pulmonary Disease | 48610 | KY |
NPI | 1083673180 |
---|---|
Provider Name | Dr. Frederick Jay Rosenblum |
First Address | Augusta, GA 30904-4887 |
Second Address | Paducah, KY 42001-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000473668F | (05) | GA |
28641 | GA LICENSE NUMBER (01) | GA |
E02284 | (02) | GA |
G28641 | (05) | SC |