Provider Demographics
NPI:1962520932
Name:ROSE, TERRI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:LYNN
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERRANCE
Other - Middle Name:LYNN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5307 W. LOOP 289
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414
Mailing Address - Country:US
Mailing Address - Phone:866-541-7731
Mailing Address - Fax:
Practice Address - Street 1:1313 CR 19
Practice Address - Street 2:SMITH UNIT
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331
Practice Address - Country:US
Practice Address - Phone:866-541-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0028208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice