Provider Demographics
NPI:1447367925
Name:ROSE, DONAL B (MD)
Entity type:Individual
Prefix:
First Name:DONAL
Middle Name:B
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0669
Mailing Address - Country:US
Mailing Address - Phone:817-596-8200
Mailing Address - Fax:817-596-8203
Practice Address - Street 1:924 FOSTER LN
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5714
Practice Address - Country:US
Practice Address - Phone:817-596-8200
Practice Address - Fax:817-596-8203
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2609207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145322701Medicaid
TX145322701Medicaid
TXH40046Medicare UPIN