Provider Demographics
NPI:1851440614
Name:RGR VENTURES LLC
Entity Type:Organization
Organization Name:RGR VENTURES LLC
Other - Org Name:BREVARD PODIATRY GROUP OR ROBERT ROSEN, DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-267-3233
Mailing Address - Street 1:PO BOX 541427
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-1427
Mailing Address - Country:US
Mailing Address - Phone:321-267-3233
Mailing Address - Fax:321-267-5141
Practice Address - Street 1:850 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-3411
Practice Address - Country:US
Practice Address - Phone:321-267-3233
Practice Address - Fax:321-267-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00179443OtherMEDICARE RAILROAD
FLP00179443OtherMEDICARE RAILROAD
FLK6629Medicare PIN