Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A91162 | CA |
NPI | 1033220611 |
---|---|
Provider Name | Phillip Leon Ross |
First Address | Oakland, CA 94609-3424 |
Second Address | Oakland, CA 94609-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 13/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A911620 | (05) | CA |