Healthcare Provider Details

I. General information

NPI: 1912988692
Provider Name (Legal Business Name): DOUGLAS AUGUSTUS ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-7200
  • Fax:
Mailing address:
  • Phone: 850-416-2928
  • Fax: 850-416-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number033354
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME 120665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: