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General NPI Number Information
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NPI Number | 1063611465
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Entity Type | Organization
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Legal Business Name | GORDON F. ROSE, PC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 544 W UMPQUA ST STE 104
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City | ROSEBURG
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State | OR
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Zip | 97470-2999
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Country | US
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Telephone | 541-673-3334
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Fax | 541-673-0814
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Provider Business Mailing Address
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Address Line | 544 W UMPQUA ST STE 104
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City | ROSEBURG
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State | OR
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Zip | 97470-2999
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Country | US
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Telephone | 541-673-3334
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Fax | 541-673-0814
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON FREDERIK ROSE
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Credential | MD
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Telephone | 541-673-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD15903
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License Number State | OR
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