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NPI Code Detail

MEDICARE: JOSE J ROSALES MD PA

MEDICARE: JOSE J ROSALES MD PA
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1639105778
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOSE J ROSALES MD PA
Provider Business Mailing Address
First Line : 1035 TOWN CENTER DR
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-8360
Country : US
Telephone Number : 386-775-8229
Fax Number : 386-775-2270
Provider Business Practice Location Address
First Line : 1035 TOWN CENTER DR
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-8360
Country : US
Telephone Number : 386-775-8229
Fax Number : 386-775-2270
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOSE J ROSALES
Credential : M.D.
Telephone Number : 386-775-8229
Provider Enumeration Date : 06/23/2006
Last Update Date : 10/15/2007

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