Provider Demographics
NPI:1619266988
Name:GARY H ROSEN MD PA
Entity Type:Organization
Organization Name:GARY H ROSEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-476-9229
Mailing Address - Street 1:4117 PASADENA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77503-3534
Mailing Address - Country:US
Mailing Address - Phone:281-476-9229
Mailing Address - Fax:281-476-1913
Practice Address - Street 1:4117 PASADENA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77503-3534
Practice Address - Country:US
Practice Address - Phone:281-476-9229
Practice Address - Fax:281-476-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-7726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00CE579Medicaid
TXP00CE579Medicaid
TX00CE57Medicare PIN