Individual
MARY ANN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
(505) 913-8900
Mailing address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
C43111
CA
2085R0001X
Radiation Oncology Physician
Primary
MD2015-0619
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C431110
—
CA
Enumeration date
11/30/2005
Last updated
07/06/2016
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