Individual
ANTHONY MAX ROUSSELOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1600 WEEOT WAY, ARCATA, CA 95521-4734
(707) 825-5010
(707) 825-6736
Mailing address
1600 WEEOT WAY, ARCATA, CA 95521-4734
(707) 825-5010
(707) 825-6736
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA13540
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EN021Z
MEDICARE PART B - PTAN
CA
Enumeration date
07/12/2005
Last updated
09/14/2022
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