MEDICARE: M. ROSS SELIGSON, PH.D., P.A.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1164711503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. ROSS SELIGSON, PH.D., P.A.

Provider Business Mailing Address
First Line	:	915 MIDDLE RIVER DRIVE
Second Line	:	SUITE 520
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3561
Country	:	US
Telephone Number	:	954-563-2800
Fax Number	:	954-563-9771

Provider Business Practice Location Address
First Line	:	915 MIDDLE RIVER DRIVE
Second Line	:	SUITE 520
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3561
Country	:	US
Telephone Number	:	954-563-2800
Fax Number	:	954-563-9771

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. M. ROSS SELIGSON
Credential	:	PH.D.
Telephone Number	:	954-563-2800

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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