Healthcare Provider Details

I. General information

NPI: 1417944349
Provider Name (Legal Business Name): SCOTT M ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 LINCOLN ST
WHITEHALL WI
54773-8605
US

IV. Provider business mailing address

18601 LINCOLN ST
WHITEHALL WI
54773-8605
US

V. Phone/Fax

Practice location:
  • Phone: 715-538-4361
  • Fax:
Mailing address:
  • Phone: 715-538-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number21367
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number29881
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number64674
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: