Healthcare Provider Details

I. General information

NPI: 1659588325
Provider Name (Legal Business Name): ELIZABETH GAYE ROSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 TURKEY LAKE RD STE 209
ORLANDO FL
32819-4206
US

IV. Provider business mailing address

8501 VERESE CT
ORLANDO FL
32836-8755
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-5252
  • Fax:
Mailing address:
  • Phone: 407-996-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME 80973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: