Provider Demographics
NPI:1700939311
Name:ROSENQUIST, MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:ROSENQUIST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:123 MEDICAL PARK LN STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4981
Mailing Address - Country:US
Mailing Address - Phone:936-291-2116
Mailing Address - Fax:936-435-7824
Practice Address - Street 1:123 MEDICAL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4981
Practice Address - Country:US
Practice Address - Phone:936-291-2116
Practice Address - Fax:936-435-7824
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN0417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02866Medicare UPIN