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General NPI Number Information
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NPI Number | 1396056073
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Entity Type | Individual
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Provider Name | JEFFREY RONALD ROSKE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 710 N 12TH ST
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City | GUTHRIE CENTER
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State | IA
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Zip | 50115-1549
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Country | US
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Telephone | 641-332-2201
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Fax | 641-332-3856
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Provider Business Mailing Address
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Address Line | 710 N 12TH ST
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City | GUTHRIE CENTER
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State | IA
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Zip | 50115-1549
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Country | US
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Telephone | 641-332-2201
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Fax | 641-332-3856
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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 | 4211
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License Number State | IA
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