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Individual
MATTHEW DAVID ROSE
Active
Individual
MATTHEW DAVID ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA STUDENT
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/23/2017
Last updated
08/12/2024
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