Provider Demographics
NPI:1629088968
Name:ROSE, JULIAN F (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:F
Last Name:ROSE
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:PO BOX 320538
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0538
Mailing Address - Country:US
Mailing Address - Phone:601-982-7111
Mailing Address - Fax:601-981-2524
Practice Address - Street 1:403 TOWNE CENTER BLVD
Practice Address - Street 2:STE. 101A
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4843
Practice Address - Country:US
Practice Address - Phone:601-982-7111
Practice Address - Fax:601-981-2524
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08416207P00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010055Medicaid
MS290000040Medicare PIN
MS1629088968Medicare NSC
MSC48044Medicare UPIN