Provider Demographics
NPI:1659559318
Name:RONALD GLENN ROSEN, MD PC
Entity Type:Organization
Organization Name:RONALD GLENN ROSEN, MD PC
Other - Org Name:EUFAULA GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-688-7350
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36072-0126
Mailing Address - Country:US
Mailing Address - Phone:334-688-7350
Mailing Address - Fax:334-688-7353
Practice Address - Street 1:825 W WASHINGTON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1847
Practice Address - Country:US
Practice Address - Phone:334-688-7350
Practice Address - Fax:334-688-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1659559318Medicaid
AL510G020002Medicare PIN