MEDICARE: DR. ROSS STUART KAPLAN 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	207N00000X	Dermatology Physician	A55764	CA
2	207NS0135X	Procedural Dermatology Physician	A55764	CA
3	207ND0101X	MOHS-Micrographic Surgery Physician	A55764	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77-0545291	OTHER		TAX ID

General Provider Information

NPI Number	:	1982600011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS STUART KAPLAN MD

Provider Business Mailing Address
First Line	:	3615 LAS POSAS RD
Second Line	:	STE F100
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1479
Country	:	US
Telephone Number	:	805-484-2813
Fax Number	:	805-484-2316

Provider Business Practice Location Address
First Line	:	3615 LAS POSAS RD
Second Line	:	STE F100
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1479
Country	:	US
Telephone Number	:	805-484-2813
Fax Number	:	805-484-2316

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/09/2013

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