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Organization
WILEY ROOSTH MD & ASSOCIATES
Active
Organization
WILEY ROOSTH MD & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILEY ROOSTH M.D. (CEO)
(903) 592-8181
Entity
Organization
Contact information
Practice address
1025 HOSPITAL DR, TYLER, TX 75701-2023
(903) 592-8181
(903) 592-8113
Mailing address
1025 HOSPITAL DR, TYLER, TX 75701-2023
(903) 592-8181
(903) 592-8113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
B9174
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030768801
—
TX
Enumeration date
08/27/2009
Last updated
08/27/2009
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