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General NPI Number Information
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NPI Number | 1003892027
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Entity Type | Individual
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Provider Name | DOUGLAS J. ROSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 45 MOHOULI ST
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City | HILO
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State | HI
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Zip | 96720-7210
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Country | US
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Telephone | 808-932-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 1091 APONO PL
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City | HILO
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State | HI
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Zip | 96720-2701
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Country | US
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Telephone | 423-341-5473
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Fax | 888-960-2830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18758
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License Number State | HI
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