Healthcare Provider Details

I. General information

NPI: 1649343872
Provider Name (Legal Business Name): BARRIE W ROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 JEFFERSON NE SUITE E
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

7301 JEFFERSON NE SUITE E
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-341-0000
  • Fax: 505-341-1495
Mailing address:
  • Phone: 505-341-0000
  • Fax: 505-341-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number93377
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: