Provider Demographics
NPI:1801816996
Name:ROSE, MANUEL SILVA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:SILVA
Last Name:ROSE
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 1:4133 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3462
Mailing Address - Country:US
Mailing Address - Phone:727-781-3888
Mailing Address - Fax:727-784-0616
Practice Address - Street 1:4133 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3462
Practice Address - Country:US
Practice Address - Phone:727-781-3888
Practice Address - Fax:727-784-0616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME517292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2669OtherBCBS PROVIDER ID
FLV2667OtherBCBS PROVIDER ID
FLV2668OtherBCBS PROVIDER ID
FLV3015OtherBCBS PROVIDER ID
FLV3119OtherBCBS PROVIDER ID
FLV2669OtherBCBS PROVIDER ID
FLV3119OtherBCBS PROVIDER ID
FLE6774BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLE6776Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLV2668OtherBCBS PROVIDER ID
FLV2667OtherBCBS PROVIDER ID