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Individual

SCOTTY R ROSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
101 S EISENHOWER DR, BECKLEY, WV 25801-4929
(304) 256-7100
(304) 256-7111
Mailing address
PO BOX 634715, CINCINNATI, OH 45263-0001

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
624
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1780627885
WV
Enumeration date
06/14/2006
Last updated
07/16/2020
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