Healthcare Provider Details

I. General information

NPI: 1104930585
Provider Name (Legal Business Name): ALAN LAWRENCE ROSE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HOLLYWOOD BLVD
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

3242 LAURELOAK LANE
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-2211
  • Fax:
Mailing address:
  • Phone: 954-981-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number26780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: