Provider Demographics
NPI:1861488827
Name:ROSE, JAMES TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TODD
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 71ST ST
Mailing Address - Street 2:SUITE 42
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2394
Mailing Address - Country:US
Mailing Address - Phone:806-799-2991
Mailing Address - Fax:806-793-5331
Practice Address - Street 1:4417 71ST ST
Practice Address - Street 2:SUITE 42
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2394
Practice Address - Country:US
Practice Address - Phone:806-799-2991
Practice Address - Fax:806-793-5331
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI15977Medicare UPIN
TX8C2391Medicare PIN
NM346633109Medicare PIN
TX8C2391Medicare ID - Type Unspecified