Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 23218 | FL |
NPI | 1104960665 |
---|---|
Provider Name | Dr. Eli Rose |
First Address | Tampa, FL 33634-7417 |
Second Address | Tampa, FL 33629-7223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AR6520870 | DEA (01) | FL |
D58412 | (02) | FL |