Provider Demographics
NPI:1487656955
Name:ROZUM, JENNIFER SUE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:ROZUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 SOARING OWL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-1832
Mailing Address - Country:US
Mailing Address - Phone:702-396-9147
Mailing Address - Fax:702-396-5013
Practice Address - Street 1:3100 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0436
Practice Address - Country:US
Practice Address - Phone:702-255-5025
Practice Address - Fax:702-255-5015
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10814207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503112Medicaid
NV39110Medicare PIN
G22266Medicare UPIN
NVV39110Medicare PIN