Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D5186 | TX |
NPI | 1003834680 |
---|---|
Provider Name | James Rose |
First Address | Austin, TX 78701-1926 |
Second Address | Austin, TX 78701-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 13/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120554405 | (05) | TX |
120554406 | (05) | TX |
120554407 | (05) | TX |
8CJ395 | BCBS (01) | TX |
P00228178 | RAILROAD MEDICARE (01) | TX |