Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD00017397 | WA |
NPI | 1114035748 |
---|---|
Provider Name | Dr. Robert J Rose |
First Address | Spokane, WA 99228-8780 |
Second Address | Spokane, WA 99218-1242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 20/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1331206 | (05) | WA |
A07368 | (02) | WA |