Individual
JEROME ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RT
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
Mailing address
PO BOX 600, TUBA CITY, AZ 86045-0600
(928) 283-2781
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
521689
AZ
Other
Enumeration date
04/07/2014
Last updated
04/07/2014
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