Individual
DR. SUSAN A ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1725 E 19TH ST, SUITE 800, TULSA, OK 74104-5472
(918) 301-2505
(918) 301-3633
Mailing address
1725 E 19TH ST, SUITE 800, TULSA, OK 74104-5472
(918) 301-2505
(918) 301-3633
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
14809
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020047731
RAILROAD MEDICARE
OK
05
—
100162600A
—
OK
Enumeration date
07/05/2006
Last updated
03/10/2010
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