Individual
GLEN STANLEY ROSEBOROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2480 LIBERTY ST NE, SUITE 110, SALEM, OR 97301-8381
(503) 371-1756
(503) 584-7971
Mailing address
2480 LIBERTY ST NE, SUITE 110, SALEM, OR 97301-8381
(503) 371-1756
(503) 584-7971
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD150190
OR
2086S0129X
Vascular Surgery Physician
Primary
MD150190
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500612667
—
OR
01
—
P00800072
RAILROAD MEDICARE
OR
Enumeration date
06/21/2006
Last updated
11/13/2024
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