Healthcare Provider Details

I. General information

NPI: 1548244122
Provider Name (Legal Business Name): CARY ROSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ZEAGLER DR STE 101
PALATKA FL
32177-3860
US

IV. Provider business mailing address

PO BOX 551308
JACKSONVILLE FL
32255-1308
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-3333
  • Fax: 904-493-2222
Mailing address:
  • Phone: 904-622-9040
  • Fax: 904-309-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number47083
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberP7558
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberP7558
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37063
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME138201
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number37063
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP7558
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD2022-0044
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: