Provider Demographics
NPI:1477532125
Name:ROSENBERGER, JAY A (DO)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:ROSENBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-8222
Mailing Address - Fax:515-241-4118
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-8222
Practice Address - Fax:515-241-4118
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA02222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA110073410OtherRR MEDICARE
IA1477532125Medicaid
IA0057760Medicaid
IA59458Medicare PIN
IAE06893Medicare UPIN