Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 12437 | AZ |
NPI | 1194790188 |
---|---|
Provider Name | Dr. Marc J Rosen |
First Address | Phoenix, AZ 85027-4013 |
Second Address | Phoenix, AZ 85027-4013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
220046 | (05) | AZ |
3Z3941 | HEALTHNET (01) | AZ |