Healthcare Provider Details

I. General information

NPI: 1417310681
Provider Name (Legal Business Name): JORDAN ROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 03/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW HOSPITALS AND CLINICS 600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

UW HOSPITALS AND CLINICS 600 HIGHLAND AVE
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6400
  • Fax:
Mailing address:
  • Phone: 608-263-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6407-851
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6407-851
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: