Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC24580 | CA |
NPI | 1801994975 |
---|---|
Provider Name | Dr. Allan Sutherland Ross |
First Address | Roseville, CA 95661-4583 |
Second Address | Roseville, CA 95661-4583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |