Provider Demographics
NPI:1285632760
Name:ROSE, MARC C (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:C
Last Name:ROSE
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:PO BOX 644373
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32964-4373
Mailing Address - Country:US
Mailing Address - Phone:772-564-1799
Mailing Address - Fax:772-494-1975
Practice Address - Street 1:49 ROYAL PALM PT STE 100
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4270
Practice Address - Country:US
Practice Address - Phone:772-564-1799
Practice Address - Fax:772-494-1975
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 48626208800000X
FLME48626208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31193OtherFL BLUE
88244226132960A003OtherTRICARE - MILITARY
P02682780OtherRAILROAD MEDICARE
FL31193ZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBR