Basic Information
| Provider Information | |||||||||
| NPI: | 1073790903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSAINZ | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 S OLD DIXIE HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617442200 | ||||||||
| FaxNumber: | 5617443083 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 S OLD DIXIE HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617442200 | ||||||||
| FaxNumber: | 5617443083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 07/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME109846 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 14HZ8 | 01 | FL | BCBS OF FLORIDA | OTHER | 004323100 | 05 | FL | MEDICAID | P00986277 | 01 | FL | RR MEDICARE | OTHER |