Provider Demographics
NPI:1316029887
Name:ROSE, GREGORY HUGH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HUGH
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13737 NOEL RD
Mailing Address - Street 2:STE 1600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1331
Mailing Address - Country:US
Mailing Address - Phone:469-401-2386
Mailing Address - Fax:972-437-3369
Practice Address - Street 1:10901 W. TOLLER DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6312
Practice Address - Country:US
Practice Address - Phone:303-933-8270
Practice Address - Fax:972-437-3369
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ78402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG13737Medicare UPIN
TX8F6967Medicare PIN