Provider Demographics
NPI:1457546517
Name:MESSING, ROSWELL III (PHD)
Entity Type:Individual
Prefix:
First Name:ROSWELL
Middle Name:
Last Name:MESSING
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:RUSS
Other - Middle Name:
Other - Last Name:MESSING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:633 CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-576-7875
Mailing Address - Fax:707-576-7875
Practice Address - Street 1:633 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-576-7875
Practice Address - Fax:707-576-7875
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY123752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PL123750Medicare PIN