Healthcare Provider Details

I. General information

NPI: 1932204096
Provider Name (Legal Business Name): ROSS MARTIN MATHIEU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD BASSETT ARMY COMMUNITY HOSPITAL
FORT WAINWRIGHT AK
99703-5002
US

IV. Provider business mailing address

1060 GAFFNEY RD BASSETT ARMY COMMUNITY HOSPITAL
FORT WAINWRIGHT AK
99703-5002
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5960
  • Fax:
Mailing address:
  • Phone: 907-361-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDOS-1065
License Number StateHI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: