Provider Demographics
NPI:1336865187
Name:ROSSER, ALEXIS D
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:D
Last Name:ROSSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 LEE ST APT 12
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3262
Mailing Address - Country:US
Mailing Address - Phone:305-972-5800
Mailing Address - Fax:
Practice Address - Street 1:721 LEE ST APT 12
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3262
Practice Address - Country:US
Practice Address - Phone:214-872-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011834871347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle