Provider Demographics
NPI:1740299957
Name:ROSE, JAMES E
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:E
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6265
Mailing Address - Country:US
Mailing Address - Phone:719-636-1201
Mailing Address - Fax:719-636-1326
Practice Address - Street 1:2920 N CASCADE AVE
Practice Address - Street 2:STE 301
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6265
Practice Address - Country:US
Practice Address - Phone:719-636-1201
Practice Address - Fax:719-636-1326
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5195207R00000X
CODR.0052809207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N821OtherBCBS
ARI28082Medicare UPIN
OK200050230AMedicaid
CA5N821Medicare PIN
AR07040015800OtherQUALCHOICE
ARP00387233OtherRAILROAD MEDICARE1
ARP00387233OtherRAILROAD MEDICARE1