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1134553019 NPI number — ROSS DERMTOLOGY

NPI Number: 1134553019
Health Care Provider/Practitioner: ROSS DERMTOLOGY

Information about “1134553019” NPI (ROSS DERMTOLOGY) exists in 1134553019 in HTML format HTML  |  1134553019 in plain Text format TXT  |  1134553019 in PDF (Portable Document Format) PDF  |  1134553019 in an XML format XML  formats.

NPI Number : 1134553019 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134553019",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ROSS DERMTOLOGY",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2611 N MAIN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN ANTONIO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78212-2920",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "210-225-2769",
    "MailingAddressFaxNumber": "210-222-9275",
    "FirstLinePracticeLocationAddress": "2611 N MAIN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN ANTONIO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78212-2920",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-225-2769",
    "PracticeLocationAddressFaxNumber": "210-222-9275",
    "EnumerationDate": "08/27/2013",
    "LastUpdateDate": "11/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ROSS",
    "AuthorizedOfficialFirstName": "KIM",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "210-225-2769",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": "K6276",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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