Provider Demographics
NPI:1467762021
Name:JAMES TODD ROSE, M.D., P.A.
Entity Type:Organization
Organization Name:JAMES TODD ROSE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-799-2991
Mailing Address - Street 1:4417 71ST ST
Mailing Address - Street 2:SUITE 42
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2394
Mailing Address - Country:US
Mailing Address - Phone:806-799-2991
Mailing Address - Fax:806-793-5331
Practice Address - Street 1:4417 71ST ST
Practice Address - Street 2:SUITE 42
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2394
Practice Address - Country:US
Practice Address - Phone:806-799-2991
Practice Address - Fax:806-793-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9460207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty