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General NPI Number Information
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NPI Number | 1376700229
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Entity Type | Individual
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Provider Name | ROSS JOSEPH REGA DPM
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Gender | Male
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 8052 ROYAL BIRKDALE CIR
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2534
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Country | US
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Telephone | 941-907-1127
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Fax | 941-907-0731
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Provider Business Mailing Address
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Address Line | 8052 ROYAL BIRKDALE CIR
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2534
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Country | US
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Telephone | 941-907-1127
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Fax | 941-907-0731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00114000
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License Number State | NJ
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