Healthcare Provider Details

I. General information

NPI: 1992761829
Provider Name (Legal Business Name): ROSS FLATHOUSE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 9TH ST STE 260
LUBBOCK TX
79415-3300
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3544
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-8185
  • Fax: 806-792-9180
Mailing address:
  • Phone: 806-785-7676
  • Fax: 806-785-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: