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NPI Code Detail

MEDICARE: LENA ROSE M.D.

MEDICARE: LENA 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
1207P00000XEmergency Medicine PhysicianE3325AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15M725OTHERARBCBS

General Provider Information

NPI Number : 1235165077
Entity Type Code : Individual
Provider Name (Legal Business Name) : LENA ROSE M.D.
Provider Business Mailing Address
First Line : 2909 MILITARY RD
Second Line :
City : BENTON
State : AR
Zip : 72015-2721
Country : US
Telephone Number : 501-315-6500
Fax Number : 501-315-0006
Provider Business Practice Location Address
First Line : 2909 MILITARY RD
Second Line :
City : BENTON
State : AR
Zip : 72015-2721
Country : US
Telephone Number : 501-315-6500
Fax Number : 501-315-0006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 07/08/2007

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Directions to “ LENA ROSE M.D.” Practice Location

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