Provider Demographics
NPI:1215903216
Name:ROUSE, DAVID T JR (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:ROUSE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:STE 104
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-1001
Mailing Address - Fax:816-792-0408
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:STE 104
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-1001
Practice Address - Fax:816-792-0408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2004018557207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I29262Medicare UPIN
K64D838Medicare ID - Type Unspecified