Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 14109 | CA |
Y | 208800000X | Urologist | DO2978 | ME |
N | 208800000X | Urologist | Q1012 | TX |
NPI | 1063640555 |
---|---|
Provider Name | Curtis P. Ross |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04401-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 03/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102899831 | (05) | PA |