Roseborough, Glen S
Roseborough, Glen S is an individual health care provider with primary practice located at 2480 Liberty St Ne Suite 110, Salem OR 97301-8381. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular Surgery, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Roseborough, Glen S can be contacted via phone (503) 371-1756.Contact Information
Primary practice address
2480 Liberty St Ne Suite 110
Salem OR 97301-8381
Phone: (503) 371-1756
Fax: (503) 584-7971
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | MD150190 | Oregon |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | MD150190 | Oregon |
Profile Details
| NPI number | 1518903186 |
|---|---|
| LBN Legal business name | Roseborough, Glen S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2006 |
| Last updated | Sep 1st, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518903186 | NPPES |
| Oregon | MEDICAID | 500612667 | |
| Oregon | Other | P00800072 |
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