Individual
SHANA WIDICK ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1011 BOWLES AVE, SUITE 415, FENTON, MO 63026-2395
(636) 717-1700
(636) 203-4727
Mailing address
1011 BOWLES AVE, SUITE 200, FENTON, MO 63026-2395
(636) 717-1700
(636) 203-4727
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2011014018
MO
Other
Enumeration date
07/17/2008
Last updated
01/23/2015
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