Healthcare Provider Details

I. General information

NPI: 1235497280
Provider Name (Legal Business Name): SHARON E ROSS OWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18949 MARSH LN STE 1110
DALLAS TX
75287-2100
US

IV. Provider business mailing address

18949 MARSH LN STE 1110
DALLAS TX
75287-2100
US

V. Phone/Fax

Practice location:
  • Phone: 940-783-5475
  • Fax:
Mailing address:
  • Phone: 940-783-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number45-5149906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: