Individual
DR. JODY GENE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4400 GRANT BLVD STE 110, YUKON, OK 73099-0038
(405) 733-1711
(405) 733-3111
Mailing address
4400 GRANT BLVD STE 110, YUKON, OK 73099-0038
(405) 733-1711
(405) 733-3111
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
204
OK
213ES0103X
Foot & Ankle Surgery Podiatrist
204
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200522012
MEDICARE GROUP
OK
01
—
P00010135
RAILROAD MEDICARE
OK
Enumeration date
07/21/2005
Last updated
08/21/2023
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