Provider Demographics
NPI:1396805149
Name:JOSEPH, ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16401 NW 2ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6036
Mailing Address - Country:US
Mailing Address - Phone:305-947-4734
Mailing Address - Fax:305-944-0619
Practice Address - Street 1:16401 NW 2ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6036
Practice Address - Country:US
Practice Address - Phone:305-947-4734
Practice Address - Fax:305-944-0619
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME59619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057855000Medicaid