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General NPI Number Information
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NPI Number | 1104176007
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Entity Type | Organization
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Legal Business Name | ROSE FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 1499 SE TECH CENTER PL SUITE 135
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City | VANCOUVER
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State | WA
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Zip | 98683-5528
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Country | US
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Telephone | 360-861-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 1499 SE TECH CENTER PL SUITE 135
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City | VANCOUVER
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State | WA
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Zip | 98683-5528
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Country | US
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Telephone | 360-861-6433
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MATTHEW HOWARD ROSE
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Credential | D.O.
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Telephone | 360-861-6433
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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 | OP60287355
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License Number State | WA
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