=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508837105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN L. ROSE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2006
-----------------------------------------------------
Last Update Date | 09/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1745 ASHLAND ST
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-664-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1208 BEALL LN
-----------------------------------------------------
City | CENTRAL POINT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97502-1573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-664-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD19001
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------