Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 34.014078 | OH |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 34.014078 | OH |
NPI | 1013362722 |
---|---|
Provider Name | Haileigh Ross |
First Address | Dublin, OH 43016-4141 |
Second Address | Columbus, OH 43215-4602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2016 |
Last Update Date | 05/11/2020 |