Individual
BRYAN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8142 S 68TH EAST AVE, TULSA, OK 74133-4177
(918) 551-6787
(918) 551-6787
Mailing address
8142 S 68TH EAST AVE, TULSA, OK 74133-4177
(918) 551-6787
(918) 551-6787
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200497250A
—
OK
Enumeration date
02/16/2015
Last updated
02/18/2015
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