Provider Demographics
NPI:1013948959
Name:ROSEN, EVAN G (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:G
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 WILSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:818-649-1000
Mailing Address - Fax:
Practice Address - Street 1:2 UPPER RAGSDALE DR BLDG A
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5736
Practice Address - Country:US
Practice Address - Phone:831-333-3040
Practice Address - Fax:831-886-3639
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68557208800000X
CAG143954208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP988893OtherFREEDOM
FL16933OtherWELLCARE
FLS817401OtherCAREPLUS
FL5898115OtherAETNA
FL203920OtherAVMED
FL3781724OtherCIGNA
FL5301OtherDIMENSION HEALTH PPO
FLP968835OtherOPTIMUM
FL27150OtherBCBS
FL5898115OtherAETNA