MEDICARE: RUTH ROSEN 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
1	207P00000X	Emergency Medicine Physician	C63110	CA
2	207Q00000X	Family Medicine Physician	MD2006-0507	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124231972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ROSEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4000
Second Line	:
City	:	POLACCA
State	:	AZ
Zip	:	86042-4000
Country	:	US
Telephone Number	:	928-737-6000
Fax Number	:	928-737-6001

Provider Business Practice Location Address
First Line	:	HOPI HEALTH CARE CENTER HIGWAY 264
Second Line	:	MM 388
City	:	POLACCA
State	:	AZ
Zip	:	86042-4000
Country	:	US
Telephone Number	:	928-737-6000
Fax Number	:	928-737-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	05/09/2024

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Directions to “ RUTH ROSEN M.D.” Practice Location

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