MEDICARE: DR. LARA L. ROSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	18007	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00113837	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	731-04011	OTHER	BLUE CROSS OF AL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093797623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARA L. ROSS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5166
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-5166
Country	:	US
Telephone Number	:	601-703-4282
Fax Number	:	601-703-4597

Provider Business Practice Location Address
First Line	:	1500 HWY 19 N
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39307-5335
Country	:	US
Telephone Number	:	601-696-3232
Fax Number	:	601-696-3231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/06/2013

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Directions to “ DR. LARA L. ROSS M.D.” Practice Location

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