Provider Demographics
NPI:1316169501
Name:ROSADO MORALES, JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:ROSADO MORALES
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 1:12300 BEAR PLZ STE 408
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-9501
Mailing Address - Country:US
Mailing Address - Phone:817-585-1768
Mailing Address - Fax:817-585-1373
Practice Address - Street 1:12300 BEAR PLZ STE 408
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-9501
Practice Address - Country:US
Practice Address - Phone:817-585-1768
Practice Address - Fax:817-585-1373
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6625207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218262804Medicaid
TX218262801Medicaid