Healthcare Provider Details

I. General information

NPI: 1003911777
Provider Name (Legal Business Name): ROSE FOOT AND ANKLE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 GRANT BLVD STE 110
YUKON OK
73099-0038
US

IV. Provider business mailing address

4400 GRANT BLVD STE 110
YUKON OK
73099-0038
US

V. Phone/Fax

Practice location:
  • Phone: 405-733-1711
  • Fax: 405-733-3111
Mailing address:
  • Phone: 405-733-1711
  • Fax: 405-733-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JODY GENE ROSE
Title or Position: OWNER
Credential: DPM
Phone: 405-733-1711