Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 1286 | TX |
NPI | 1013250455 |
---|---|
Provider Name | Jeremy Aaron Ross |
First Address | Fort Worth, TX 76104-4611 |
Second Address | Fort Worth, TX 76104-4611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
358870905 | (05) | TX |