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General NPI Number Information
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NPI Number | 1467673251
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Entity Type | Individual
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Provider Name | DORIS GWENDOLYN ROSS MD
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 73 4434 MAMALAHOA HWY
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City | KAILUA KONA
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State | HI
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Zip | 96740
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Country | US
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Telephone | 808-325-3255
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Fax | 808-325-3255
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Provider Business Mailing Address
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Address Line | PO BOX 4998
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City | KAILUA KONA
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State | HI
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Zip | 96745-4998
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Country | US
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Telephone | 808-325-3255
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Fax | 808-325-3255
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD8129
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD 8129
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License Number State | HI
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