Provider Demographics
NPI:1609984772
Name:ROSEN, GARY HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:HOWARD
Last Name:ROSEN
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 1:4117 PASADENA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77503-3534
Mailing Address - Country:US
Mailing Address - Phone:281-476-9229
Mailing Address - Fax:281-476-1913
Practice Address - Street 1:4117 PASADENA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77503-3534
Practice Address - Country:US
Practice Address - Phone:281-476-9229
Practice Address - Fax:281-476-1913
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000CE579Medicaid
C21290Medicare UPIN
00CE57Medicare ID - Type Unspecified