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Organization
EL ROSE MEDICAL GROUP
Active
Organization
EL ROSE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID A SISLER MD (OWNER)
(707) 763-9491
Entity
Organization
Contact information
Practice address
24 WEST EL ROSE AVE, PETALUMA, CA 94952
(707) 763-9891
(707) 763-9896
Mailing address
24 WEST EL ROSE AVE, PETALUMA, CA 94952
(707) 763-9891
(707) 763-9896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AROSE0543
BLUE CROSS BLUE SHIELD
—
01
—
C17753
STATE LICENSE #
—
01
—
C26495
STATE LICENSE #
—
01
—
CP6140
RAILROAD MEDICARE
—
01
—
G21106
STATE LICENSE #
—
01
—
ZZZ75987Z
MEDI CAL
—
Enumeration date
11/08/2006
Last updated
07/08/2008
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