Provider Demographics
NPI:1124017900
Name:ROSDEUTSCHER, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:ROSDEUTSCHER
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 1:1187 OLD HICKORY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4240
Mailing Address - Country:US
Mailing Address - Phone:615-866-2233
Mailing Address - Fax:615-750-5968
Practice Address - Street 1:1187 OLD HICKORY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4240
Practice Address - Country:US
Practice Address - Phone:615-866-2233
Practice Address - Fax:615-750-5968
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30390208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6032349OtherBCBS TN
TN3716120Medicaid
TN1510486Medicaid
TN3826892Medicare PIN
TN3716120Medicaid
TN1510486Medicaid