Provider Demographics
NPI:1063483980
Name:ROSEN, JEFFREY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PETER
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 W CRYSTAL LAKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4475
Mailing Address - Country:US
Mailing Address - Phone:407-254-2500
Mailing Address - Fax:407-254-2557
Practice Address - Street 1:2699 LEE RD STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1738
Practice Address - Country:US
Practice Address - Phone:407-897-1363
Practice Address - Fax:407-254-2557
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME44077207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040516700Medicaid
FL477072Medicare ID - Type Unspecified
D55152Medicare UPIN