Provider Demographics
NPI:1497747059
Name:ROSENTHAL, J. EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:EDWARD
Last Name:ROSENTHAL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JED
Other - Middle Name:
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE A202
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2584
Mailing Address - Country:US
Mailing Address - Phone:972-566-7733
Mailing Address - Fax:972-720-5803
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE A202
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2584
Practice Address - Country:US
Practice Address - Phone:972-566-7733
Practice Address - Fax:972-720-5803
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4288207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136795511Medicaid
TX136795512Medicaid
TXTXB114944Medicare PIN
D67687Medicare UPIN
TXP00910180Medicare PIN
TXTXB115200Medicare PIN