Organization
THE ROSE CLINIC FOR PLASTIC AND MIGRAINE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN G ROSE M.D. (DOCTOR/OWNER)
(801) 375-7673
Entity
Organization
Contact information
Practice address
320 RIVER PARK DR, SUITE 245, PROVO, UT 84604-6060
(801) 375-7673
(801) 375-7679
Mailing address
320 RIVER PARK DR, SUITE245, PROVO, UT 84604-6060
(801) 375-7673
(801) 375-7679
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5575028-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528431055001
—
UT
Enumeration date
01/07/2008
Last updated
06/13/2008
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