Provider Demographics
NPI:1114089224
Name:ROSMAN, JONATHAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:ROSMAN
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:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-1830
Mailing Address - Country:US
Mailing Address - Phone:970-845-8059
Mailing Address - Fax:970-845-8062
Practice Address - Street 1:2810 E DEL MAR BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4321
Practice Address - Country:US
Practice Address - Phone:970-845-8059
Practice Address - Fax:970-845-8062
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA441022084F0202X, 2084P0800X, 2084P0802X
CO421262084F0202X, 2084P0800X, 2084P0802X, 2084S0012X
CAA440122084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA17139Medicare UPIN