MEDICARE: PAMELA ROSS PA-C

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	363AM0700X	Medical Physician Assistant	PA9104169	FL

General Provider Information

NPI Number	:	1124202734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ROSS PA-C

Provider Business Mailing Address
First Line	:	3280C S ATLANTIC AVE # 48
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-6247
Country	:	US
Telephone Number	:	386-341-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 DUNLAWTON AVE
Second Line	:	INSTITUTE FOR WELLBEING SUITE 102
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4931
Country	:	US
Telephone Number	:	386-763-2338
Fax Number	:

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	11/17/2008

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