MEDICARE: DR. ROSET SAMUEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	96-360	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073590162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSET SAMUEL M.D.

Provider Business Mailing Address
First Line	:	4371 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-532-8900
Fax Number	:	575-532-8974

Provider Business Practice Location Address
First Line	:	4371 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-532-8900
Fax Number	:	575-532-8974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	09/14/2023

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Directions to “ DR. ROSET SAMUEL M.D.” Practice Location

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