Provider Demographics
NPI:1164483368
Name:ROSE, BRIAN T (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4587
Mailing Address - Country:US
Mailing Address - Phone:903-465-2190
Mailing Address - Fax:903-465-2262
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:SUITE 120
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-465-2190
Practice Address - Fax:903-465-2262
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3103207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178388801Medicaid
TXH53207Medicare UPIN
TXTXB111221Medicare PIN