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General NPI Number Information
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NPI Number | 1407985971
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Entity Type | Organization
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Legal Business Name | DAVID E ROSS, JR, MD,PC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 1619 W 5TH AVE
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City | GARY
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State | IN
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Zip | 46404-1506
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Country | US
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Telephone | 219-886-4788
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Fax | 219-886-4106
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Provider Business Mailing Address
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Address Line | PO BOX 4787
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City | GARY
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State | IN
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Zip | 46404-0787
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Country | US
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Telephone | 219-886-4788
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Fax | 219-886-4106
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. NATHANIEL ROSS I
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Credential | M.D.
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Telephone | 219-886-4788
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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 |
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License Number State |
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