Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | A88152 | CA |
NPI | 1003837675 |
---|---|
Provider Name | Jack C Rose |
First Address | Sacramento, CA 95865-4947 |
Second Address | San Francisco, CA 94115-2373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 26/10/2011 |