Provider Demographics
NPI:1861929796
Name:ROSE, MATTHEW DAVID (PA STUDENT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:ROSE
Suffix:
Gender:M
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N DONALD ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-1637
Mailing Address - Country:US
Mailing Address - Phone:940-631-1339
Mailing Address - Fax:
Practice Address - Street 1:850 N 6TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5242
Practice Address - Country:US
Practice Address - Phone:325-692-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Single Specialty