Healthcare Provider Details

I. General information

NPI: 1245690650
Provider Name (Legal Business Name): JUSTIN CAMERON ROSS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3843 RIO VISTA DR STE 2200
COLORADO SPRINGS CO
80917-3381
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-4120
  • Fax: 719-364-4121
Mailing address:
  • Phone: 970-624-4123
  • Fax: 970-624-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR.0068658
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberDR.0068658
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: