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General NPI Number Information
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NPI Number | 1265727457
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Entity Type | Individual
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Provider Name | COURTNEY E ROSE D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 203 NACOGDOCHES ST SUITE 275
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2462
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Country | US
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Telephone | 309-541-5472
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Fax | 903-541-5470
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Provider Business Mailing Address
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Address Line | 203 NACOGDOCHES ST SUITE 275
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2462
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Country | US
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Telephone | 309-541-5472
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Fax | 903-541-5470
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N9947
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License Number State | TX
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