Provider Demographics
NPI:1801981162
Name:ROSEN, ALAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DAVID
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 708
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2725
Mailing Address - Country:US
Mailing Address - Phone:713-795-4763
Mailing Address - Fax:713-795-4246
Practice Address - Street 1:6560 FANNIN ST STE 708
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2725
Practice Address - Country:US
Practice Address - Phone:713-795-4763
Practice Address - Fax:713-795-4246
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115403102Medicaid
C21291Medicare UPIN
TX115403102Medicaid