Organization
CLOWN PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY WADE ROSCOE M.D. (PHYSICIAN)
(317) 881-8737
Entity
Organization
Contact information
Practice address
401 CAMBY CT, GREENWOOD, IN 46142-4085
(317) 881-8737
(317) 881-8735
Mailing address
401 CAMBY CT, GREENWOOD, IN 46142-4085
(317) 881-8737
(317) 881-8735
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1057187 A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200479420 A
—
IN
Enumeration date
06/04/2007
Last updated
05/09/2011
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