Provider Demographics
NPI:1447524046
Name:ROSE, DEBRA RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:RUTH
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 E MORRISON LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3047
Mailing Address - Country:US
Mailing Address - Phone:480-596-5324
Mailing Address - Fax:
Practice Address - Street 1:5429 E MORRISON LN
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-3047
Practice Address - Country:US
Practice Address - Phone:480-596-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19498208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics