Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X007933 | NY |
NPI | 1316161094 |
---|---|
Provider Name | Dr. Jeffrey Allan Ross |
First Address | Geneva, NY 14456-2713 |
Second Address | Elma, NY 14059-9494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U64973 | (02) | NY |