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General NPI Number Information
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NPI Number | 1194051623
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Entity Type | Organization
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Legal Business Name | CHARLES ROSS MD PA
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Dates
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Enumeration Date | 10/17/2009
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 511 W ALEXANDER ST SUITE 1
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City | PLANT CITY
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State | FL
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Zip | 33563-7116
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Country | US
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Telephone | 813-719-7246
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Fax | 813-464-2781
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Provider Business Mailing Address
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Address Line | 1721 POWDER RIDGE DR
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City | VALRICO
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State | FL
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Zip | 33594-4040
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Country | US
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Telephone | 813-389-7582
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Fax | 813-464-2781
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES ROSS
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Credential | MD
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Telephone | 813-270-0325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME96407
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License Number State | FL
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