Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME0030403 | FL |
NPI | 1033118385 |
---|---|
Provider Name | Dr. Thomas H Ross |
First Address | Lake Worth, FL 33467-2964 |
Second Address | Lake Worth, FL 33467-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 26/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D62712 | (02) |