Provider Demographics
NPI:1194198093
Name:ROSSI, ROSCOE
Entity Type:Individual
Prefix:
First Name:ROSCOE
Middle Name:
Last Name:ROSSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 E NEW HAVEN AVE
Mailing Address - Street 2:#804
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7390
Mailing Address - Country:US
Mailing Address - Phone:321-750-7505
Mailing Address - Fax:
Practice Address - Street 1:1211 E NEW HAVEN AVE
Practice Address - Street 2:#804
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7390
Practice Address - Country:US
Practice Address - Phone:321-750-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME10795207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology