MEDICARE: JAY H ROSS MD PA

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	174400000X	Specialist	ME60124	FL

General Provider Information

NPI Number	:	1730400615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY H ROSS MD PA

Provider Business Mailing Address
First Line	:	35080 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1925
Country	:	US
Telephone Number	:	727-789-5711
Fax Number	:	727-789-4098

Provider Business Practice Location Address
First Line	:	35080 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1925
Country	:	US
Telephone Number	:	727-789-5711
Fax Number	:	727-789-4098

Authorized Official
Title or Position	:	M.D.
Name	:	JAY H ROSS
Credential	:	M.D.
Telephone Number	:	727-789-5711

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	08/17/2010

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