Healthcare Provider Details

I. General information

NPI: 1831401884
Provider Name (Legal Business Name): ROSE ORTHOPEDICS AND SPINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 S US HIGHWAY 75 SUITE 120
DENISON TX
75020-4587
US

IV. Provider business mailing address

5012 S US HIGHWAY 75 SUITE 120
DENISON TX
75020-4587
US

V. Phone/Fax

Practice location:
  • Phone: 903-465-2190
  • Fax: 903-465-2262
Mailing address:
  • Phone: 903-465-2190
  • Fax: 903-465-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberL3103
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberL3103
License Number StateTX

VIII. Authorized Official

Name: BRIAN T. ROSE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 903-465-2190