Provider Demographics
NPI:1760545784
Name:BROSE, JOHN ADOLPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADOLPH
Last Name:BROSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OHIO UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Mailing Address - Street 2:204 GROSVENOR HALL
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-593-9350
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY MEDICAL ASSOCIATES INC.
Practice Address - Street 2:2ND FLOOR PARKS HALL
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003304B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0487754Medicaid
OHBR0519952Medicare ID - Type Unspecified
OH0487754Medicaid