MEDICARE: ROBERT SCOTT ROSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5391	NV

General Provider Information

NPI Number	:	1184660326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SCOTT ROSEN M.D.

Provider Business Mailing Address
First Line	:	2780 S JONES BLVD
Second Line	:	STE #B
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5625
Country	:	US
Telephone Number	:	702-871-6686
Fax Number	:	702-871-7099

Provider Business Practice Location Address
First Line	:	2780 S JONES BLVD
Second Line	:	STE #B
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5625
Country	:	US
Telephone Number	:	702-871-6686
Fax Number	:	702-871-7099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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