MEDICARE: DR. JENNIFER LYNN ROSS MD

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	207ZP0101X	Anatomic Pathology Physician	BP1-0022188	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2790078954	OTHER		MYUTMB 2790078954-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1508060195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN ROSS MD

Provider Business Mailing Address
First Line	:	1751 W WALKER ST APT 9106
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4297
Country	:	US
Telephone Number	:	713-206-3943
Fax Number	:

Provider Business Practice Location Address
First Line	:	1885 OLD SPANISH TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2001
Country	:	US
Telephone Number	:	713-796-6804
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	01/24/2011

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