Provider Demographics
NPI:1851308787
Name:ROOSTH, JOSEPH HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HOWARD
Last Name:ROOSTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1834 BROADWAY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5668
Mailing Address - Country:US
Mailing Address - Phone:281-997-8181
Mailing Address - Fax:281-997-8184
Practice Address - Street 1:1834 BROADWAY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5668
Practice Address - Country:US
Practice Address - Phone:281-997-8181
Practice Address - Fax:281-997-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128481204Medicaid
TX00K97UMedicare PIN
TX128481204Medicaid