Provider Demographics
NPI:1417228867
Name:J.D. ROSSI, M.D., PH.D., P.A.
Entity Type:Organization
Organization Name:J.D. ROSSI, M.D., PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-292-1508
Mailing Address - Street 1:21 WATERWAY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3099
Mailing Address - Country:US
Mailing Address - Phone:281-292-1508
Mailing Address - Fax:281-292-9091
Practice Address - Street 1:17198 ST LUKES WAY
Practice Address - Street 2:SUITE 650
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-8011
Practice Address - Country:US
Practice Address - Phone:281-292-1508
Practice Address - Fax:281-292-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty