Provider Demographics
NPI:1831134667
Name:SIMONIAN, ROSE S (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:S
Last Name:SIMONIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:2200 EPHRIHAM AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-6642
Practice Address - Country:US
Practice Address - Phone:817-702-6500
Practice Address - Fax:817-702-8670
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2108207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180857804Medicaid
TX8AA713OtherBCBS
TX8AA713OtherBCBS
TXI45906Medicare UPIN