Provider Demographics
NPI:1659588325
Name:ROSEN, ELIZABETH GAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GAYE
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 VERESE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-8755
Mailing Address - Country:US
Mailing Address - Phone:407-996-2845
Mailing Address - Fax:
Practice Address - Street 1:6000 TURKEY LAKE RD STE 209
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4206
Practice Address - Country:US
Practice Address - Phone:407-648-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 80973207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine