Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 6800 | FL |
NPI | 1831183581 |
---|---|
Provider Name | Dr. Jon Nelson Rosenthal |
First Address | Plantation, FL 33324-2754 |
Second Address | Plantation, FL 33324-2754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0546175002 | CIGNA (01) | FL |
0853275 | AETNA (01) | FL |
F83896 | (02) | FL |