Provider Demographics
NPI:1205096906
Name:ROSEDALE, MICHAEL JAMES (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:ROSEDALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:19106 MAZATTAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2342
Mailing Address - Country:US
Mailing Address - Phone:707-495-0922
Mailing Address - Fax:210-650-9067
Practice Address - Street 1:11901 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 1201
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3161
Practice Address - Country:US
Practice Address - Phone:210-650-9066
Practice Address - Fax:210-650-9067
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2017-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR2459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine