Provider Demographics
NPI:1558328294
Name:ROSALES, JUSTO EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTO
Middle Name:EDGAR
Last Name:ROSALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:E
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:737 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5103
Mailing Address - Country:US
Mailing Address - Phone:785-827-7261
Mailing Address - Fax:785-827-6334
Practice Address - Street 1:737 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5103
Practice Address - Country:US
Practice Address - Phone:785-827-7261
Practice Address - Fax:785-827-6334
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419504208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS046185Medicare PIN