MEDICARE: MR. ALAN MAC ROSS AUD/CCC-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	231H00000X	Audiologist	51167	TX

General Provider Information

NPI Number	:	1700860483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN MAC ROSS AUD/CCC-A

Provider Business Mailing Address
First Line	:	PSC 561 BOX 2182
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96310-0022
Country	:	US
Telephone Number	:	254-759-9823
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 561 BOX 2182
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96310-0022
Country	:	US
Telephone Number	:	254-759-9823
Fax Number	:

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	02/03/2025

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