Provider Demographics
NPI:1558336909
Name:ROSE, BRUCE IRWIN (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:IRWIN
Last Name:ROSE
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8149 POINT MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9111
Mailing Address - Country:US
Mailing Address - Phone:904-260-0352
Mailing Address - Fax:904-363-9818
Practice Address - Street 1:8149 POINT MEADOWS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9111
Practice Address - Country:US
Practice Address - Phone:904-260-0352
Practice Address - Fax:904-363-9818
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129612207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF15334Medicare UPIN