Individual
DR. C MARK ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
902 WOLLARD BLVD, RICHMOND, MO 64085
(816) 776-2201
(816) 776-7678
Mailing address
902 WOLLARD BLVD, RICHMOND, MO 64085
(816) 776-2201
(816) 480-4515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R8G83
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13238051
BCBS
MO
05
—
242411015
—
MO
Enumeration date
02/28/2006
Last updated
07/24/2024
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