Doctor Name: | GORDON FREDERIK ROSE |
NPI Number: | 1861454761 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD15903 |
Business Practice Address: | 1749 Nw Riverview Dr Roseburg, OR - 974716104 |
Business Phone Number: | 5416777184 |
Business Fax Number: | |
Mailing Address: | 1749 Nw Riverview Dr, ROSEBURG |
State: | OR |
Postal Code: | 974716104 |
Phone Number: | 5416777184 |
Fax Number: | |
NPI Enumeration Date: | 04/05/2006 |
NPI Last Update Date: | 09/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD15903 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |