MEDICARE: DOUGLAS B 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	207P00000X	Emergency Medicine Physician	9436	NV

General Provider Information

NPI Number	:	1679645444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS B ROSS MD

Provider Business Mailing Address
First Line	:	3061 S MARYLAND PKWY STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6226
Country	:	US
Telephone Number	:	702-622-8895
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 S MARYLAND PKWY STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6226
Country	:	US
Telephone Number	:	702-622-8895
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	05/06/2015

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