Provider Demographics
NPI:1578079356
Name:ROSE, BRIAN PTARICK (PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PTARICK
Last Name:ROSE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4406
Mailing Address - Country:US
Mailing Address - Phone:910-321-1012
Mailing Address - Fax:
Practice Address - Street 1:3656 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4406
Practice Address - Country:US
Practice Address - Phone:910-321-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-16
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant