Healthcare Provider Details

I. General information

NPI: 1780031906
Provider Name (Legal Business Name): RACHEL LAUREN ROSS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 OMEGA DR
TYLER TX
75701-6653
US

IV. Provider business mailing address

2946 S UNIVERSITY DR APT 7209
DAVIE FL
33328-1458
US

V. Phone/Fax

Practice location:
  • Phone: 254-541-7196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2370
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: