1972555217 NPI number — JEFFREY BRUCE ROSEN MD

Table of content: YARSELLIS FROMETA DELGADO (NPI 1811645146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972555217 NPI number — JEFFREY BRUCE ROSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSEN
Provider First Name:
JEFFREY
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972555217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 MINORCA AVE, 2ND FLOOR
Provider Second Line Business Mailing Address:
PRIMECARE OF CORAL GABLES
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-443-3001
Provider Business Mailing Address Fax Number:
786-235-8575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 MINORCA AVE, 2ND FLOOR
Provider Second Line Business Practice Location Address:
PRIMECARE OF CORAL GABLES
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-443-3001
Provider Business Practice Location Address Fax Number:
305-441-9427
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME40205 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000101545 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 102120 . This is a "UNITED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME00040205 . This is a "LICENSE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0000667 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0994 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2689498 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 377234900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96041 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 204472 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 009688700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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