Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 26543 | KY |
N | 207RC0000X | Internist - Cardiovascular Disease | 35.090841 | OH |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 26543 | KY |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 35.090841 | OH |
Y | 207RI0011X | Interventional Cardiology | 26543 | KY |
N | 207RI0011X | Interventional Cardiology | 35.090841 | OH |
NPI | 1154311926 |
---|---|
Provider Name | Terence Conrad Ross |
First Address | Lexington, KY 40509-1805 |
Second Address | Lexington, KY 40509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 01/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0085877000 | (05) | WV |
060064447 | RR MEDICARE (01) | |
0802215 | (05) | OH |
64265432 | (05) | KY |
E08309 | (02) |