Provider Demographics
NPI:1396749701
Name:ROSE, JEFFREY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
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 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:STE 203B
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-857-1130
Mailing Address - Fax:253-857-1121
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:STE 203B
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-857-1130
Practice Address - Fax:253-857-1121
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022810207RC0000X, 207RC0001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0247344OtherSTATE L&I
WA0249912OtherSTATE L&I
WAG8906702OtherMEDICARE
WA0150352OtherWA STATE DEPARTMENT OF L&
WA060065814OtherRAILROAD MEDICARE
WA0257325OtherSTATE L&I
WA0290111OtherL&I
WAP00765954OtherRAILROAD
WA8950251OtherCRIME VICTIM
WA5406ROOtherREGENCE HEALTHCARE
WA634841-001OtherGROUP HEALTH
WAP00826850OtherRAILROAD
WA1005040Medicaid
WA0245392OtherSTATE L&I
WA0245561OtherSTATE L&I
WA0301000OtherSTATE L&I
WA0150352OtherWA STATE DEPARTMENT OF L&
WA1005040Medicaid
WA0245561OtherSTATE L&I
WA0257325OtherSTATE L&I
WA8854567Medicare PIN