Healthcare Provider Details

I. General information

NPI: 1073590162
Provider Name (Legal Business Name): ROSET SAMUEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8900
  • Fax: 575-532-8974
Mailing address:
  • Phone: 575-532-8900
  • Fax: 575-532-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96-360
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: