MEDICARE: DR. SCOTT K ROOS 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
1	207Q00000X	Family Medicine Physician	2004023370	MO

General Provider Information

NPI Number	:	1770596983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT K ROOS MD

Provider Business Mailing Address
First Line	:	6261 RONALD REAGAN DR STE B19
Second Line	:
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-2665
Country	:	US
Telephone Number	:	636-561-3021
Fax Number	:	636-561-3022

Provider Business Practice Location Address
First Line	:	6261 RONALD REAGAN DR
Second Line	:	STE B19
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-2665
Country	:	US
Telephone Number	:	636-561-3021
Fax Number	:	636-561-3022

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	03/15/2021

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