Provider Demographics
NPI:1043237647
Name:ROSENTHAL, HARRY JR (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:ROSENTHAL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-423-3943
Practice Address - Street 1:4932 OVERTON RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1909
Practice Address - Country:US
Practice Address - Phone:817-423-3937
Practice Address - Fax:817-423-3943
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5555207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138791214Medicaid
TX138791215Medicaid
P00096820OtherRAILROAD