Provider Demographics
NPI:1720204001
Name:ROSE Z. GOWEN, M.D., P.A.
Entity Type:Organization
Organization Name:ROSE Z. GOWEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-504-6800
Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6329
Mailing Address - Country:US
Mailing Address - Phone:956-504-9199
Mailing Address - Fax:
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6329
Practice Address - Country:US
Practice Address - Phone:956-504-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9089925207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081114301Medicaid
TXA12494Medicare UPIN
TX0075BVMedicare ID - Type UnspecifiedMEDICARE GROUP