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Contact Information

KENNETH D ROSE, MD
603 MEDICAL PARKWAY
ENTERPRISE, OR97828
 Phone: 541-426-3870
 Fax: 541-426-1901
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery

208600000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for KENNETH D ROSE · (Male)

NPI Number 1588658801
Status Active
Credentials MD
Entity Individual
Enumeration date 09/01/2005
Last updated 12/04/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01055738
  • OR License # 28952
  • IN Medicaid 200355260
Hospital affiliation(s)
  • GRANDE RONDE HOSPITAL - (Critical Access)
    900 SUNSET DRIVE
    LA GRANDE, OR 97850
  • WALLOWA MEMORIAL HOSPITAL - (Critical Access)
    601 MEDICAL PARKWAY
    ENTERPRISE, OR 97828
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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