Individual
DR. JEREMY WADE ROSCOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 CAMBY CT, GREENWOOD, IN 46142-4085
(317) 881-8737
(317) 881-8735
Mailing address
1516 TREVOR CT, GREENWOOD, IN 46143-6465
(317) 859-1160
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1057187
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200479420A
—
IN
01
—
371487209
TAX ID
IN
Enumeration date
12/15/2005
Last updated
05/09/2011
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