Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2006036681 | MO |
NPI | 1003843228 |
---|---|
Provider Name | Dr. Gary Michael Rosas |
First Address | Washington, MO 63090-3135 |
Second Address | Washington, MO 63090-3135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 17/12/2008 |