Healthcare Provider Details

I. General information

NPI: 1932887593
Provider Name (Legal Business Name): ROSE CITY UROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4293 KINSEY DR
TYLER TX
75703-1004
US

IV. Provider business mailing address

4293 KINSEY DR
TYLER TX
75703-1004
US

V. Phone/Fax

Practice location:
  • Phone: 318-376-5030
  • Fax:
Mailing address:
  • Phone: 903-690-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN WEBSTER TUBRE
Title or Position: MD/OWNER
Credential: MD
Phone: 903-690-7775