Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | DR.0058606 | CO |
NPI | 1003233214 |
---|---|
Provider Name | Dr. Brandon Patrick Ross |
First Address | Highlands Ranch, CO 80129-2251 |
Second Address | Highlands Ranch, CO 80129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DR.0058606 | MEDICAL LICENSE (01) | CO |