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NPI Code Detail

MEDICARE: DR. MARVIN E ROSS DO

MEDICARE: DR. MARVIN E ROSS DO
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
1207Q00000XFamily Medicine PhysicianR6529MO

Other Identifiers

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

General Provider Information

NPI Number : 1346221231
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVIN E ROSS DO
Provider Business Mailing Address
First Line : 1502 N JEFFERSON ST
Second Line : JEFFERSON MEDICAL GROUP /ATTN: JEAN STEELE
City : CARROLLTON
State : MO
Zip : 64633-1948
Country : US
Telephone Number : 660-542-9998
Fax Number : 660-542-9880
Provider Business Practice Location Address
First Line : 1502 N JEFFERSON ST
Second Line : JEFFERSON MEDICAL GROUP /ATTN: JEAN STEELE
City : CARROLLTON
State : MO
Zip : 64633-1948
Country : US
Telephone Number : 660-542-9998
Fax Number : 660-542-9880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 05/06/2016

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