Healthcare Provider Details

I. General information

NPI: 1932406279
Provider Name (Legal Business Name): GARY J. ROSENBAUM, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD SUITE 720
MIAMI BEACH FL
33140-4556
US

IV. Provider business mailing address

4308 ALTON RD SUITE 720
MIAMI BEACH FL
33140-4556
US

V. Phone/Fax

Practice location:
  • Phone: 305-538-7726
  • Fax: 305-538-7725
Mailing address:
  • Phone: 305-538-7726
  • Fax: 305-538-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME60122
License Number StateFL

VIII. Authorized Official

Name: GARY J ROSENBAUM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-538-7726