Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | L3103 | TX |
N | 207XS0117X | Orthopaedic Spine Surgeon | L3103 | TX |
NPI | 1164483368 |
---|---|
Provider Name | Brian T Rose |
First Address | Denison, TX 75020-4587 |
Second Address | Denison, TX 75020-4587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
178388801 | (05) | TX |
H53207 | (02) | TX |