Provider Demographics
NPI:1750393534
Name:ROSENCRANTZ, DAVID RICHARD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:ROSENCRANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 NE 28TH ST STE B
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4524
Practice Address - Country:US
Practice Address - Phone:541-812-5800
Practice Address - Fax:541-812-5802
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07089208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232702Medicaid
OR232702Medicaid
WA7107782OtherWASH WELFARE
WA7107782OtherWASH WELFARE
OR340015577OtherRR MEDICARE LINC CITY OR
OR136947Medicare PIN
C93654Medicare UPIN
OR232702Medicaid
OR0005042002OtherORE TEAMSTERS
ORA002OtherTRICARE PRIME