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NPI Code Detail

MEDICARE: DOUGLAS Y ROESE MD

MEDICARE: DOUGLAS Y ROESE MD
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
1174400000XSpecialist1052691AIN

General Provider Information

NPI Number : 1699889162
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS Y ROESE MD
Provider Business Mailing Address
First Line : 2325 18TH ST STE 220
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-5389
Country : US
Telephone Number : 812-372-2245
Fax Number : 812-375-2156
Provider Business Practice Location Address
First Line : 2325 18TH ST STE 220
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-5389
Country : US
Telephone Number : 812-372-2245
Fax Number : 812-375-2156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/08/2007

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Directions to “ DOUGLAS Y ROESE MD” Practice Location

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