Healthcare Provider Details

I. General information

NPI: 1578833737
Provider Name (Legal Business Name): SYDNEY PHILLIP ROSS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 NORTH TOMBSTONE ROAD
SCOTTSDALE AZ
85258
US

IV. Provider business mailing address

7408 NORTH TOMBSTONE ROAD
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 480-315-1207
  • Fax:
Mailing address:
  • Phone: 480-315-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number1476
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number10570
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: