Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 200200790 | NC |
N | 207XS0117X | Orthopaedic Spine Surgeon | 200200790 | NC |
NPI | 1205828886 |
---|---|
Provider Name | Dr. Daniel Todd Rose |
First Address | Wilmington, NC 28412-2489 |
Second Address | Wilmington, NC 28412-2489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 14/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200200790 | MEDICAL LICENSE (01) | NC |
5915497 | (05) | NC |
P00897683 | RR MEDICARE (01) |