Provider Demographics
NPI:1508098112
Name:ROSALES, JOHN PAUL GERARD NAZARENO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN PAUL GERARD
Middle Name:NAZARENO
Last Name:ROSALES
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 1:2 TAMPA GENERAL CIR FL 6
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3603
Mailing Address - Country:US
Mailing Address - Phone:813-259-8668
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR FL 6
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74149208M00000X
FLME123374207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021638300Medicaid
FLXO9TZOtherBLUE CROSS BLUE SHIELD