Individual
DR. WALTER H ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
122 E BAKER ST, INDIANOLA, MS 38751-2451
(662) 887-2212
(662) 887-1279
Mailing address
122 E BAKER ST, INDIANOLA, MS 38751-2451
(662) 887-2212
(662) 887-1279
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4712
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114777
—
MS
Enumeration date
09/27/2006
Last updated
05/03/2010
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