Healthcare Provider Details

I. General information

NPI: 1780680454
Provider Name (Legal Business Name): JASON J ROSENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W NEWBERRY RD
GAINESVILLE FL
32607-2245
US

IV. Provider business mailing address

4500 W NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-6000
  • Fax: 352-336-6039
Mailing address:
  • Phone: 352-336-6000
  • Fax: 352-332-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME76245
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME76245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: