Provider Demographics
NPI:1275734022
Name:ROUSE, CHRISTOPHER ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:ROUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2344
Mailing Address - Country:US
Mailing Address - Phone:816-892-5323
Mailing Address - Fax:816-584-0557
Practice Address - Street 1:6352 N COSBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2344
Practice Address - Country:US
Practice Address - Phone:816-892-5323
Practice Address - Fax:816-584-0557
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008007454207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39910018OtherBCBS
MOP00622825OtherRAILROAD MEDICARE
MOG26B00001Medicare PIN