Provider Demographics
NPI:1033151089
Name:ROSS, ARTHUR REYNOLD JR (PHD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:REYNOLD
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SIJAN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEMAN AIR FORCE BASE
Mailing Address - State:MO
Mailing Address - Zip Code:65305-3234
Mailing Address - Country:US
Mailing Address - Phone:660-687-4341
Mailing Address - Fax:660-687-5256
Practice Address - Street 1:331 SIJAN AVE
Practice Address - Street 2:
Practice Address - City:WHITEMAN AIR FORCE BASE
Practice Address - State:MO
Practice Address - Zip Code:65305-3234
Practice Address - Country:US
Practice Address - Phone:660-687-4341
Practice Address - Fax:660-687-5256
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1088103TC0700X
MO2001031481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30450016OtherBCBS OF KC
A084OtherTRICARE