Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP5256 | AZ |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP5256 | AZ |
NPI | 1003238312 |
---|---|
Provider Name | Mr. Daniel Leon Ross JR. |
First Address | Tucson, AZ 85704-7711 |
Second Address | Tucson, AZ 85704-7711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2014 |
Last Update Date | 04/05/2017 |