Provider Demographics
NPI:1699771071
Name:ROSEQUIST, ROBERT BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:ROSEQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26827 FOGGY CREEK RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6768
Mailing Address - Country:US
Mailing Address - Phone:813-973-7774
Mailing Address - Fax:813-973-8862
Practice Address - Street 1:26827 FOGGY CREEK RD STE 101A
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6768
Practice Address - Country:US
Practice Address - Phone:813-973-7774
Practice Address - Fax:813-973-8862
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02510YMedicare PIN
FL02510Medicare PIN
FLD50540Medicare UPIN