MEDICARE: ROSS DERMATOLOGY

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	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134553019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS DERMATOLOGY

Provider Business Mailing Address
First Line	:	2611 N MAIN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2920
Country	:	US
Telephone Number	:	210-225-2769
Fax Number	:	830-341-5593

Provider Business Practice Location Address
First Line	:	2611 N MAIN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2920
Country	:	US
Telephone Number	:	210-225-2769
Fax Number	:	830-341-5593

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIM M ROSS
Credential	:	M.D.
Telephone Number	:	210-225-2769

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	01/22/2026

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Directions to “ROSS DERMATOLOGY ” Practice Location

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