=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174056501
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDAN ROSS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2017
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 N DUNLAP ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38105-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-287-7337
-----------------------------------------------------
Fax | 901-287-5506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 POPLAR AVE BLDG 2
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38105-4607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-287-7337
-----------------------------------------------------
Fax | 901-287-5595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 62230
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | 35272
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | 62230
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------