Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 10476 | WV |
N | 222Z00000X | Podiatrist | 10476 | WV |
N | 213E00000X | Podiatrist | PO4089 | FL |
N | 222Z00000X | Podiatrist | PO4089 | FL |
Y | 213E00000X | Podiatrist | SC007077 | PA |
Y | 222Z00000X | Podiatrist | SC007077 | PA |
NPI | 1003349762 |
---|---|
Provider Name | Richard Andrew Ross |
First Address | Hialeah, FL 33016-1801 |
Second Address | Brownsville, PA 15417-9603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2017 |
Last Update Date | 14/07/2020 |