Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 006670 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | 016.005724 | IL |
NPI | 1003250556 |
---|---|
Provider Name | Jonathan Duane Rouse |
First Address | Omaha, NE 68134-6139 |
Second Address | Omaha, NE 68134-6139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 01/04/2020 |