Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 20A18178 | CA |
N | 207YS0123X | Facial Plastic Surgeon | 5101018567 | MI |
N | 207YS0123X | Facial Plastic Surgeon | OP60519665 | WA |
NPI | 1205147659 |
---|---|
Provider Name | Jason D. Roos |
First Address | Visalia, CA 93291-6163 |
Second Address | Spokane, WA 99204-2823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 03/02/2022 |