MEDICARE: JEREMY MICHAEL ROSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	31424	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063890697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY MICHAEL ROSS M.D.

Provider Business Mailing Address
First Line	:	329 S 38TH ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-4945
Country	:	US
Telephone Number	:	918-687-9999
Fax Number	:	918-686-7078

Provider Business Practice Location Address
First Line	:	329 S 38TH ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-4945
Country	:	US
Telephone Number	:	918-687-9999
Fax Number	:	918-686-7078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	11/19/2025

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