Provider Demographics
NPI:1639217078
Name:ROSFELD, TIMOTHY AARON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:AARON
Last Name:ROSFELD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:NE
Mailing Address - Zip Code:68825-2589
Mailing Address - Country:US
Mailing Address - Phone:308-836-2228
Mailing Address - Fax:
Practice Address - Street 1:211 E KIMBALL ST
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:NE
Practice Address - Zip Code:68825-2589
Practice Address - Country:US
Practice Address - Phone:308-836-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE274870Medicare ID - Type Unspecified
NEP45617Medicare UPIN