Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A84955 | CA |
Y | 207YP0228X | Pediatric Otolaryngology | A84955 | CA |
NPI | 1063502839 |
---|---|
Provider Name | Dr. Frederick S Rosen |
First Address | Alameda, CA 94501-6977 |
Second Address | Brentwood, CA 94513-2252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 19/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A84955 | LICENSE (01) | CA |
I11062 | (02) | |
ZZZ21406Z | MEDICARE GR (01) |