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General NPI Number Information
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NPI Number | 1447323001
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Entity Type | Individual
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Provider Name | DIANE ELLEN ROSS M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 749 OAKLEIGH AVE
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City | GULFPORT
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State | MS
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Zip | 39507-3809
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Country | US
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Telephone | 228-896-3317
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Fax | 228-896-3314
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Provider Business Mailing Address
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Address Line | 2160 E PASS RD SUITE D
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City | GULFPORT
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State | MS
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Zip | 39507-3801
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Country | US
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Telephone | 228-896-3317
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Fax | 228-896-3314
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 09562
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License Number State | MS
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