Healthcare Provider Details

I. General information

NPI: 1467490623
Provider Name (Legal Business Name): ALEX RAYMOND ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/22/2024
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 36TH ST
VERO BEACH FL
32960
US

IV. Provider business mailing address

1265 36TH ST
VERO BEACH FL
32960
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-6340
  • Fax: 772-567-3564
Mailing address:
  • Phone: 772-567-6340
  • Fax: 772-567-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0060121
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0060121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: