Healthcare Provider Details

I. General information

NPI: 1265479810
Provider Name (Legal Business Name): JOHN CARL ROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE SUITE 5300
DENVER CO
80218-1216
US

IV. Provider business mailing address

1601 E 19TH AVE SUITE 5300
DENVER CO
80218-1216
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7440
  • Fax:
Mailing address:
  • Phone: 303-839-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number32639
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: