MEDICARE: ROSE MEDICAL GROUP, P.A.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	K0647	TX

General Provider Information

NPI Number	:	1508061482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE MEDICAL GROUP, P.A.

Provider Business Mailing Address
First Line	:	12446 WEST AVE
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2517
Country	:	US
Telephone Number	:	210-525-9900
Fax Number	:	210-525-9908

Provider Business Practice Location Address
First Line	:	12446 WEST AVE
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2517
Country	:	US
Telephone Number	:	210-525-9900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAYMOND L BREWER
Credential	:	MD
Telephone Number	:	210-525-9900

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	08/22/2020

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