Provider Demographics
NPI:1376681536
Name:LEON ROSEN, JONATHAN ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ANDRE
Last Name:LEON ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 451453
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33245-1453
Mailing Address - Country:US
Mailing Address - Phone:786-309-7579
Mailing Address - Fax:305-203-4950
Practice Address - Street 1:1850 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2731
Practice Address - Country:US
Practice Address - Phone:786-309-7579
Practice Address - Fax:305-203-4950
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104640207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001325100Medicaid
FL001325100Medicaid