Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 5575028-1205 | UT |
N | 208600000X | Surgeon | 5575028-1205 | UT |
Y | 2082S0105X | Plastic Hand Surgeon | 5575028-1205 | UT |
NPI | 1245276021 |
---|---|
Provider Name | Dr. Kevin G Rose |
First Address | Provo, UT 84604-6060 |
Second Address | Springville, UT 84663-1984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 16/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I18411 | (02) | UT |