Individual
DR. FREDRIC ROBERT ROSENBERG
Active
Individual
DR. FREDRIC ROBERT ROSENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G21402
CA
207ND0101X
MOHS-Micrographic Surgery Physician
G21402
CA
207ND0900X
Dermatopathology Physician
G21402
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
G21402
CA
207NP0225X
Pediatric Dermatology Physician
G21402
CA
207NS0135X
Procedural Dermatology Physician
G21402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G214020
—
CA
01
—
4024334
AETNA
CA
01
—
G21402
STATE LICENSE
CA
01
—
ZZZ12556Z
BLUE SHIELD
CA
Enumeration date
01/10/2007
Last updated
10/12/2010
Update your record
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