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General NPI Number Information
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NPI Number | 1528762820
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Entity Type | Individual
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Provider Name | SCOTT ROSE PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 4400 E FLAMINGO AVE STE 200
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City | NAMPA
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State | ID
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Zip | 83687-1128
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Country | US
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Telephone | 208-302-2700
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Fax | 208-302-2725
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-367-5170
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Fax | 208-367-5180
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2299
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License Number State | ID
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