Provider Demographics
NPI:1003813700
Name:ROSEN, RICHARD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRUCE
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1320
Mailing Address - Country:US
Mailing Address - Phone:775-398-1980
Mailing Address - Fax:775-398-1981
Practice Address - Street 1:781 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1320
Practice Address - Country:US
Practice Address - Phone:775-398-1980
Practice Address - Fax:775-398-1981
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-01-29
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAG59148207R00000X
NV6288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36735Medicare PIN
NVD44424Medicare UPIN