Individual
DR. JACOB DUDLEY ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
603 S ORANGE ST, NEW SMYRNA BEACH, FL 32168-7320
(386) 423-0333
(386) 423-0042
Mailing address
603 S ORANGE ST, NEW SMYRNA BEACH, FL 32168-7320
(386) 423-0333
(386) 423-0042
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME32999
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067960700
—
FL
01
—
210925
FLORIDA HEALTH CARE
FL
01
—
4055589
AETNA
FL
01
—
4703735004
CIGNA
FL
01
—
AETNA
623712
FL
Enumeration date
12/13/2005
Last updated
07/14/2014
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