Provider Demographics
NPI:1821004409
Name:DOYLE, ROSA M (PA)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SOUTH IH 35
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513
Mailing Address - Country:US
Mailing Address - Phone:254-939-2100
Mailing Address - Fax:254-939-2334
Practice Address - Street 1:3500 SOUTH IH 35
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513
Practice Address - Country:US
Practice Address - Phone:254-939-2100
Practice Address - Fax:254-939-2334
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00603363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4474Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE