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General NPI Number Information
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NPI Number | 1467762021
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Entity Type | Organization
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Legal Business Name | JAMES TODD ROSE, M.D., P.A.
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 4417 71ST ST SUITE 42
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City | LUBBOCK
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State | TX
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Zip | 79424-2394
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Country | US
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Telephone | 806-799-2991
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Fax | 806-793-5331
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Provider Business Mailing Address
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Address Line | 4417 71ST ST SUITE 42
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City | LUBBOCK
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State | TX
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Zip | 79424-2394
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Country | US
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Telephone | 806-799-2991
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Fax | 806-793-5331
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD ROSE
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Credential | M.D.
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Telephone | 806-799-2991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | L9460
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L9460
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License Number State | TX
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