Provider Demographics
NPI:1932151859
Name:ROSEN, SEYMOUR ROBERT (MD)
Entity type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:ROBERT
Last Name:ROSEN
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 1:3009 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2122
Mailing Address - Country:US
Mailing Address - Phone:850-526-3937
Mailing Address - Fax:850-526-7334
Practice Address - Street 1:3009 4TH STREET
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2122
Practice Address - Country:US
Practice Address - Phone:850-526-3937
Practice Address - Fax:850-526-7334
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026782207W00000X
GA47257207W00000X
GA047257207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057881903Medicaid
78555Medicare ID - Type Unspecified
FL057881903Medicaid