Provider Demographics
NPI:1902063282
Name:ROSTAS, JACK W III (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:W
Last Name:ROSTAS
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:3509 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1307
Mailing Address - Country:US
Mailing Address - Phone:806-799-7928
Mailing Address - Fax:806-788-8560
Practice Address - Street 1:4101 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1121
Practice Address - Country:US
Practice Address - Phone:806-799-7928
Practice Address - Fax:806-788-8560
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361439622086X0206X
TXT52002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology