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General NPI Number Information
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NPI Number | 1942295563
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Entity Type | Individual
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Provider Name | GERALD ALAN ROSS D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 10000 SW INNOVATION WAY
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-2111
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Country | US
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Telephone | 772-345-5280
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Fax | 772-345-5274
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Provider Business Mailing Address
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Address Line | 10000 SW INNOVATION WAY
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-2111
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Country | US
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Telephone | 772-345-5280
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Fax | 772-345-5274
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | OS8788
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License Number State | FL
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