Healthcare Provider Details

I. General information

NPI: 1215068085
Provider Name (Legal Business Name): JOHN F ROSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 NEWBURG RD STE 106
LOUISVILLE KY
40218-2497
US

IV. Provider business mailing address

3430 NEWBURG RD STE 106
LOUISVILLE KY
40218-2497
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-1100
  • Fax: 502-451-0345
Mailing address:
  • Phone: 502-451-1100
  • Fax: 502-451-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number16831
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: