Healthcare Provider Details

I. General information

NPI: 1689037178
Provider Name (Legal Business Name): JAMES LAWRENCE ROSE II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

2000 CANAL ST D&T BUILDING, SUITE 2720
NEW ORLEANS LA
70112-3018
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-2000
  • Fax:
Mailing address:
  • Phone: 504-702-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberV4287
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number307123
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number917240188
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27562
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: