Provider Demographics
NPI:1528052818
Name:ROSSER, JON DAVID (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:DAVID
Last Name:ROSSER
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 1:1317 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1408
Mailing Address - Country:US
Mailing Address - Phone:205-458-5000
Mailing Address - Fax:205-458-5005
Practice Address - Street 1:1317 4TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1408
Practice Address - Country:US
Practice Address - Phone:205-458-5000
Practice Address - Fax:205-458-5005
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17194208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32344Medicare UPIN