Healthcare Provider Details

I. General information

NPI: 1528052818
Provider Name (Legal Business Name): JON DAVID ROSSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 4TH AVE S
BIRMINGHAM AL
35233-1408
US

IV. Provider business mailing address

1317 4TH AVE S
BIRMINGHAM AL
35233-1408
US

V. Phone/Fax

Practice location:
  • Phone: 205-458-5000
  • Fax: 205-458-5005
Mailing address:
  • Phone: 205-458-5000
  • Fax: 205-458-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number17194
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: