MEDICARE: DR. STEVE ROSE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E1025	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5K608	OTHER	AR	AR BLUE SHIELD #

General Provider Information

NPI Number	:	1689751257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE ROSE MD

Provider Business Mailing Address
First Line	:	PO BOX 2580
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65801-2580
Country	:	US
Telephone Number	:	417-829-4620
Fax Number	:	417-829-4316

Provider Business Practice Location Address
First Line	:	1 PARKCLIFF DR
Second Line	:	SUITE C
City	:	HOLIDAY ISLAND
State	:	AR
Zip	:	72631-9234
Country	:	US
Telephone Number	:	479-363-9174
Fax Number	:	479-363-9175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. STEVE ROSE MD” Practice Location

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