Provider Demographics
NPI:1831183581
Name:ROSENTHAL, JON NELSON (DO)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:NELSON
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:220 SW 84TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2754
Mailing Address - Country:US
Mailing Address - Phone:954-796-0400
Mailing Address - Fax:954-753-6673
Practice Address - Street 1:220 SW 84TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2754
Practice Address - Country:US
Practice Address - Phone:954-796-0400
Practice Address - Fax:954-753-6673
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL6800207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0546175002OtherCIGNA
FL0853275OtherAETNA
FLF83896Medicare UPIN
FL0853275OtherAETNA