Provider Demographics
NPI:1326422841
Name:ROSE, ALEXANDER (MD, MPHS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD, MPHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 MANCHESTER RD # 282
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2602
Mailing Address - Country:US
Mailing Address - Phone:314-380-8764
Mailing Address - Fax:314-293-6893
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 555
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1265
Practice Address - Country:US
Practice Address - Phone:314-380-8764
Practice Address - Fax:314-293-6893
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160343152084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry