Provider Demographics
NPI:1972506145
Name:ROSE, STEPHEN MATTHEW (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MATTHEW
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 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:270 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2990
Practice Address - Country:US
Practice Address - Phone:615-675-2000
Practice Address - Fax:615-278-1672
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34059173000000X
TN48703207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCC1655OtherRAILROAD MEDICARE
KY64049240Medicaid
KY64049240Medicaid
KYCC1655OtherRAILROAD MEDICARE
KY0204360001Medicare NSC