Provider Demographics
NPI:1609872365
Name:ROSE, JOHNNIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:L
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 CRAWFORD ST
Mailing Address - Street 2:STE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8941
Mailing Address - Country:US
Mailing Address - Phone:713-650-6699
Mailing Address - Fax:713-650-6699
Practice Address - Street 1:2101 CRAWFORD ST
Practice Address - Street 2:STE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8941
Practice Address - Country:US
Practice Address - Phone:713-650-6699
Practice Address - Fax:713-650-6699
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE88652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21281Medicare UPIN