Healthcare Provider Details

I. General information

NPI: 1285605113
Provider Name (Legal Business Name): JAMES M ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE PALLIATIVE CARE DEPT
TULSA OK
74104-4012
US

IV. Provider business mailing address

1120 S UTICA AVE PALLIATIVE CARE DEPT
TULSA OK
74104-4012
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-3871
  • Fax: 918-579-3809
Mailing address:
  • Phone: 918-579-3871
  • Fax: 918-579-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21872
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number21872
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: