Individual
DONALD DAVID ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
521 LAKE CHRISTINE DR, BELLEVILLE, IL 62221-5101
(618) 277-9168
Mailing address
521 LAKE CHRISTINE DR, BELLEVILLE, IL 62221-5101
(618) 277-9168
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036057334
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057334
—
IL
Enumeration date
11/17/2005
Last updated
04/15/2019
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