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General NPI Number Information
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NPI Number | 1619266988
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Entity Type | Organization
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Legal Business Name | GARY H ROSEN MD PA
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 4117 PASADENA BLVD
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City | PASADENA
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State | TX
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Zip | 77503-3534
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Country | US
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Telephone | 281-476-9229
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Fax | 281-476-1913
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Provider Business Mailing Address
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Address Line | 4117 PASADENA BLVD
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City | PASADENA
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State | TX
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Zip | 77503-3534
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Country | US
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Telephone | 281-476-9229
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Fax | 281-476-1913
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY HOWARD ROSEN
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Credential | MD
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Telephone | 281-476-9229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-7726
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License Number State | TX
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