Provider Demographics
NPI:1518921618
Name:ROSE, PAUL T (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4425 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1837
Mailing Address - Country:US
Mailing Address - Phone:305-448-9100
Mailing Address - Fax:305-448-1050
Practice Address - Street 1:4425 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1837
Practice Address - Country:US
Practice Address - Phone:305-448-9100
Practice Address - Fax:305-448-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2015-12-30
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Provider Licenses
StateLicense IDTaxonomies
FLME36846207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593094664OtherTAX ID
FL09049OtherBCBS
FLK0517Medicare ID - Type Unspecified
C33691Medicare UPIN