Provider Demographics
NPI:1588602163
Name:HARRIS S. ROSE MD PLLC
Entity Type:Organization
Organization Name:HARRIS S. ROSE MD PLLC
Other - Org Name:TEXAS UPPER EXTREMITY SPECIALISTS, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-551-0375
Mailing Address - Street 1:11652 JOLLYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3935
Mailing Address - Country:US
Mailing Address - Phone:512-551-0375
Mailing Address - Fax:512-551-0634
Practice Address - Street 1:11652 JOLLYVILLE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3935
Practice Address - Country:US
Practice Address - Phone:512-551-0375
Practice Address - Fax:512-551-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4488207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6523740001OtherDMERC
00W971Medicare PIN
TX6523740001OtherDMERC