Provider Demographics
NPI:1942385653
Name:ROSE, GRAHAM CLIFTON (M D)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:CLIFTON
Last Name:ROSE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE
Mailing Address - Street 2:STE E-220
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-537-9030
Mailing Address - Fax:785-537-3334
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:STE E-220
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-9030
Practice Address - Fax:785-537-3334
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04 158882080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS02193ROOtherBLUE SHIELD
KS02193ROOtherBLUE SHIELD