Individual
SHANNON ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
275 E 200 S, VISTA, SALT LAKE CITY, UT 84111-4111
(800) 366-1884
(866) 360-6021
Mailing address
275 E 200 S, VISTA, SALT LAKE CITY, UT 84111-2002
(800) 366-1884
(866) 360-6021
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G77178
CA
208000000X
Pediatrics Physician
G77178
CA
208M00000X
Hospitalist Physician
Primary
G77178
CA
Other
Enumeration date
08/08/2006
Last updated
11/24/2009
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