Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0044077 | FL |
NPI | 1063483980 |
---|---|
Provider Name | Dr. Jeffrey Peter Rosen |
First Address | Orlando, FL 32806-4475 |
Second Address | Orlando, FL 32806-4475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D55152 | (02) |