Healthcare Provider Details

I. General information

NPI: 1053008482
Provider Name (Legal Business Name): ROSS TAYLOR DAVIDS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 N 99TH AVE STE 100
SUN CITY AZ
85351-0001
US

IV. Provider business mailing address

13640 N 99TH AVE STE 100
SUN CITY AZ
85351-0001
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0055664
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: