Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME 71082 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | ME 71082 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME 71082 | FL |
NPI | 1295761948 |
---|---|
Provider Name | Jose J Rosales |
First Address | Orange City, FL 32763-8360 |
Second Address | Orange City, FL 32763-8360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 12/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31498 | BLUE CROSS BLUE SHIELD FL (01) | FL |