| Doctor Name: | MIRIAM SHARON ROSE |
| NPI Number: | 1770812943 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | MD27475 |
| Business Practice Address: | 4060 Sw 110th Ave Beaverton, OR - 970053017 |
| Business Phone Number: | 5038191215 |
| Business Fax Number: | |
| Mailing Address: | 4060 Sw 110th Ave, BEAVERTON |
| State: | OR |
| Postal Code: | 970053017 |
| Phone Number: | 5038191215 |
| Fax Number: | |
| NPI Enumeration Date: | 12/16/2009 |
| NPI Last Update Date: | 07/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD27475 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |