Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME110614 | FL |
Y | 208600000X | Surgeon | ME110614 | FL |
N | 2086S0102X | Surgical Critical Care | ME110614 | FL |
NPI | 1083873335 |
---|---|
Provider Name | Alexander Tuan Rose |
First Address | Jacksonville, FL 32223-1613 |
Second Address | Jacksonville, FL 32207-8334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 22/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003112095A | (05) | FL |
003836600 | (05) | FL |
14FK0 | BCBSFL (01) | FL |