Provider Demographics
NPI:1558658138
Name:ROSENHAMER, J DUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:DUSTIN
Last Name:ROSENHAMER
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 1:2108 NW 173RD ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7148
Mailing Address - Country:US
Mailing Address - Phone:405-410-2477
Mailing Address - Fax:
Practice Address - Street 1:2216 NW 164TH ST
Practice Address - Street 2:STE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9078
Practice Address - Country:US
Practice Address - Phone:405-755-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK286052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology