Healthcare Provider Details

I. General information

NPI: 1043271521
Provider Name (Legal Business Name): ROBERT J. ROSE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HWY 49N
MARIPOSA CA
95338
US

IV. Provider business mailing address

PO BOX 155
MARIPOSA CA
95338-0155
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-3672
  • Fax: 209-966-5548
Mailing address:
  • Phone: 209-966-3672
  • Fax: 209-966-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT J ROSE
Title or Position: OWNER
Credential: MD
Phone: 209-966-3672