Individual
DR. MARK ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2700 SE STRATUS AVE, MCMINNVILLE, OR 97128-6255
(503) 472-6131
Mailing address
PO BOX 2065, SEATTLE, WA 98111-2065
(888) 828-3195
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD14469
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055542001
BCBS
—
05
—
068783
—
OR
01
—
57597
WA L&I
—
05
—
8202269
—
WA
01
—
930027259
RAILROAD MEDICARE
—
01
—
D86800
GROUP HEALTH
—
01
—
JM9461
PACC
—
05
—
XPY186301
—
CA
Enumeration date
07/05/2006
Last updated
12/19/2007
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