Provider Demographics
NPI:1386693851
Name:ROSSI, STEVEN BRAD (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRAD
Last Name:ROSSI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N 23RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-3058
Mailing Address - Country:US
Mailing Address - Phone:806-452-5522
Mailing Address - Fax:806-452-3070
Practice Address - Street 1:301 N 23RD ST STE C
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3058
Practice Address - Country:US
Practice Address - Phone:806-452-5522
Practice Address - Fax:806-452-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159711402Medicaid
610037Medicare ID - Type Unspecified