Provider Demographics
NPI:1104909647
Name:ROS-ESCALANTE, JUAN (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:ROS-ESCALANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 951316
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-1316
Mailing Address - Country:US
Mailing Address - Phone:407-250-3290
Mailing Address - Fax:407-250-2922
Practice Address - Street 1:1355 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2451
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1694
Practice Address - Country:US
Practice Address - Phone:407-250-3290
Practice Address - Fax:407-250-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1092692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004081800Medicaid
FLFK547ZOtherMEDICARE PTAN
FLFK547ZOtherMEDICARE PTAN