Healthcare Provider Details

I. General information

NPI: 1720055023
Provider Name (Legal Business Name): SCOTT K ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 ALA KALANIKAUMAKA ST. STE. B201
KOLOA HI
96756
US

IV. Provider business mailing address

P.O. BOX 337
WAIMEA HI
96796
US

V. Phone/Fax

Practice location:
  • Phone: 808-742-0990
  • Fax:
Mailing address:
  • Phone: 808-338-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61382215
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH2739
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: