Healthcare Provider Details

I. General information

NPI: 1023118148
Provider Name (Legal Business Name): PHILIP EUGENE ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PHILIP E ROSEN MD

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST STE 230
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

250 BLOSSOM ST STE 230
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: 281-554-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberD6156
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: