Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 7666 | AZ |
NPI | 1144870163 |
---|---|
Provider Name | Scott Ross |
First Address | Goodyear, AZ 85395-7786 |
Second Address | Usaf Academy, CO 80840-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 30/07/2020 |