Healthcare Provider Details

I. General information

NPI: 1417053661
Provider Name (Legal Business Name): DAVID ROSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W. MARTIN LUTHER KING BLVD STE #300
TAMPA FL
33607
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4435
  • Fax: 813-870-4084
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-868-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME47394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: