Provider Demographics
NPI:1073516001
Name:ROSS, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2850
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:127 CRESTVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2850
Practice Address - Country:US
Practice Address - Phone:615-446-5121
Practice Address - Fax:615-441-4507
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD37418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3884779Medicaid
TN4066286OtherBLUE CROSS BLUE SHIELD TN
P00016815OtherRAILROAD MEDICARE PIN
TN3884779Medicaid
3884779Medicare PIN