Healthcare Provider Details

I. General information

NPI: 1477759868
Provider Name (Legal Business Name): JEFFREY SCOTT ROSETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

V. Phone/Fax

Practice location:
  • Phone: 808-442-5823
  • Fax:
Mailing address:
  • Phone: 808-442-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMED-PHYS-LIC-28835
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRS20070356
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMED-PHYS-LIC-28835
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number28835
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: