Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 29643 | MN |
N | 204F00000X | Transplant Surgeon | 53223 | AZ |
N | 204F00000X | Transplant Surgeon | ME130257 | FL |
N | 208200000X | Surgeon | 29643 | MN |
N | 208600000X | Surgeon | 29643 | MN |
NPI | 1053398347 |
---|---|
Provider Name | Charles B. Rosen |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 20/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E36302 | (02) |