Provider Demographics
NPI:1487905238
Name:CHRISTOPHER R. ROSE, MD PA
Entity type:Organization
Organization Name:CHRISTOPHER R. ROSE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-791-3999
Mailing Address - Street 1:3709 22ND PL
Mailing Address - Street 2:STE A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1333
Mailing Address - Country:US
Mailing Address - Phone:806-791-3999
Mailing Address - Fax:806-791-1054
Practice Address - Street 1:3709 22ND PL
Practice Address - Street 2:STE A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1333
Practice Address - Country:US
Practice Address - Phone:806-791-3999
Practice Address - Fax:806-791-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty