Provider Demographics
NPI:1306834270
Name:ROSENBLUM, RICHARD S (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 OLD KATY RD 276
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2187
Mailing Address - Country:US
Mailing Address - Phone:713-621-7436
Mailing Address - Fax:713-963-9051
Practice Address - Street 1:7026 OLD KATY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2133
Practice Address - Country:US
Practice Address - Phone:713-621-7436
Practice Address - Fax:713-963-9051
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS81302085R0202X
OK45822085R0202X
TXM63682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187666601Medicaid
FL272018300Medicaid
TX187666601Medicaid
TX8J9415Medicare PIN
FLH15430Medicare UPIN
FL272018300Medicaid