Healthcare Provider Details

I. General information

NPI: 1114304060
Provider Name (Legal Business Name): PHILIP DANIEL S ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

IV. Provider business mailing address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-4949
  • Fax: 205-638-4982
Mailing address:
  • Phone: 205-638-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number35531
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: