Individual
MR. TY MARTIN ROSEBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1801 N SENATE BLVD, #200, INDIANAPOLIS, IN 46202-1228
(317) 802-2000
(317) 924-0115
Mailing address
14380 MAIN ST, SUITE 120, PMB 160, HESPERIA, CA 92345-4613
(760) 947-3220
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10000768A
IN
363A00000X
Physician Assistant
Primary
19182
CA
Other
Enumeration date
05/12/2006
Last updated
11/29/2021
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