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NPI Code Detail

MEDICARE: DOUGLAS J. ROSE M.D.

MEDICARE: DOUGLAS J. ROSE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician18758HI

General Provider Information

NPI Number : 1003892027
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS J. ROSE M.D.
Provider Business Mailing Address
First Line : 1091 APONO PL
Second Line :
City : HILO
State : HI
Zip : 96720-2701
Country : US
Telephone Number : 423-341-5473
Fax Number : 888-960-2830
Provider Business Practice Location Address
First Line : 45 MOHOULI ST
Second Line :
City : HILO
State : HI
Zip : 96720-7210
Country : US
Telephone Number : 808-932-3740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 05/30/2025

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