Healthcare Provider Details

I. General information

NPI: 1295178614
Provider Name (Legal Business Name): PHILLIP RANDALL ROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7690 DISCOVERY DR
WEST CHESTER OH
45069-6542
US

IV. Provider business mailing address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8690
  • Fax: 513-475-8629
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.137015
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301114341
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number35137015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: