Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | ME129612 | FL |
NPI | 1558336909 |
---|---|
Provider Name | Dr. Bruce Irwin Rose |
First Address | Jacksonville, FL 32256-9111 |
Second Address | Jacksonville, FL 32256-9111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 21/03/2019 |