Healthcare Provider Details

I. General information

NPI: 1487098059
Provider Name (Legal Business Name): JASON R ROSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 LINTON BLVD STE 203B
DELRAY BEACH FL
33445-6615
US

IV. Provider business mailing address

4675 LINTON BLVD STE 203B
DELRAY BEACH FL
33445-6615
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-5341
  • Fax: 561-499-5343
Mailing address:
  • Phone: 561-499-5341
  • Fax: 561-499-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberOS14613
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberOS14613
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberOS14613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: