Healthcare Provider Details

I. General information

NPI: 1538378336
Provider Name (Legal Business Name): PHILIP EUGENE ROSEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST SUITE 230
WEBSTER TX
77598-4241
US

IV. Provider business mailing address

250 BLOSSOM ST SUITE 250
WEBSTER TX
77598-4241
US

V. Phone/Fax

Practice location:
  • Phone: 281-554-4769
  • Fax: 281-554-4817
Mailing address:
  • Phone: 281-554-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD6156
License Number StateTX

VIII. Authorized Official

Name: PHILIP EUGENE ROSEN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 281-554-4769