Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 95-332 | NM |
NPI | 1033179841 |
---|---|
Provider Name | Dr. Jeffrey Ross |
First Address | Albuquerque, NM 87109-3587 |
Second Address | Albuquerque, NM 87109-3587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E84996 | (02) | NM |
F4516 | (05) | NM |