Provider Demographics
NPI:1598945040
Name:TREVOR A ROSE MD PA
Entity Type:Organization
Organization Name:TREVOR A ROSE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-846-0666
Mailing Address - Street 1:6551 RIDGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6868
Mailing Address - Country:US
Mailing Address - Phone:727-846-0666
Mailing Address - Fax:727-849-1474
Practice Address - Street 1:6551 RIDGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6868
Practice Address - Country:US
Practice Address - Phone:727-846-0666
Practice Address - Fax:727-849-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF07359Medicare UPIN
FL12894Medicare PIN