MEDICARE: DR. COREY SAMUEL ROSENBAUM D.O.

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	207X00000X	Orthopaedic Surgery Physician	OS13280	FL
2	207X00000X	Orthopaedic Surgery Physician	UO2075	FL

General Provider Information

NPI Number	:	1740414317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COREY SAMUEL ROSENBAUM D.O.

Provider Business Mailing Address
First Line	:	PO BOX 3266
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32085-3266
Country	:	US
Telephone Number	:	904-819-4602
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 CITY PL STE 201
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2480
Country	:	US
Telephone Number	:	386-627-7318
Fax Number	:

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

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	10/05/2020

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