Provider Demographics
NPI:1689610503
Name:ROOS, FILIP (MD)
Entity Type:Individual
Prefix:
First Name:FILIP
Middle Name:
Last Name:ROOS
Suffix:
Gender:M
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:PO BOX 660877
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95866-0877
Mailing Address - Country:US
Mailing Address - Phone:916-481-0777
Mailing Address - Fax:916-481-1881
Practice Address - Street 1:955 KELLEY CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4109
Practice Address - Country:US
Practice Address - Phone:916-481-0777
Practice Address - Fax:916-481-1881
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54519207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A545191OtherMEDICARE ID-TYPE UNSPECIFIED
CA00A545191Medicaid
00A545191OtherMEDICARE ID-TYPE UNSPECIFIED