Provider Demographics
NPI:1942240965
Name:ROUSH, THOMAS FRETZ (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:FRETZ
Last Name:ROUSH
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 1:1818 S AUSTRALIAN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-296-2450
Mailing Address - Fax:561-290-1015
Practice Address - Street 1:1818 S AUSTRALIAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-296-2450
Practice Address - Fax:561-290-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207X00000X207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCBR9083609OtherDEA REGISTRATION NUMBER