Provider Demographics
NPI:1972555217
Name:ROSEN, JEFFREY BRUCE (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRUCE
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 1:370 MINORCA AVE, 2ND FLOOR
Mailing Address - Street 2:PRIMECARE OF CORAL GABLES
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-443-3001
Mailing Address - Fax:786-235-8575
Practice Address - Street 1:370 MINORCA AVE, 2ND FLOOR
Practice Address - Street 2:PRIMECARE OF CORAL GABLES
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-443-3001
Practice Address - Fax:305-441-9427
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000101545OtherHUMANA
FL102120OtherUNITED
FLME00040205OtherLICENSE #
FL0000667OtherCIGNA
FL0994OtherNHP
FL2689498OtherAETNA
FL377234900Medicaid
FL96041OtherBCBS
FL204472OtherAVMED
FL204472OtherAVMED
FLME00040205OtherLICENSE #
FLAR96285816OtherDEA