Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Glen Stanley Roseborough, MD

Individual provider Surgery Physician · NPI 1518903186

Glen Stanley Roseborough, MD is a Vascular Surgery in Salem, Oregon. Qualified in 1991, 35 years ago. Practices with Poudre Valley Medical Group LLC, a 2,416-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
35
Licensed in
OR
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2480 Liberty St NE Ste 110
Salem, OR 97301-8381
Phone: (503) 371-1756
Fax: (503) 584-7971
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Vascular Surgery Physician (primary) Taxonomy 2086S0129X · Licence MD150190 (OR)
Surgery Physician Taxonomy 208600000X · Licence MD150190 (OR)

Record details

NPI number1518903186
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 21, 2006
Last updated in NPPESNovember 13, 2024
Certification dateNovember 13, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyVASCULAR SURGERY
Medical schoolOTHER
Graduated 1991 (35 years in practice)
Group practice Poudre Valley Medical Group Llc — 2416 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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