Provider Demographics
NPI:1093794869
Name:ROSS, WILLIAM DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637783
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7783
Mailing Address - Country:US
Mailing Address - Phone:513-853-4749
Mailing Address - Fax:513-853-4740
Practice Address - Street 1:5151 MORNING SUN RD
Practice Address - Street 2:STE A
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-9545
Practice Address - Country:US
Practice Address - Phone:513-524-5330
Practice Address - Fax:513-524-5337
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005758208VP0000X, 207P00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00341008OtherRR MEDICARE
IN200142750Medicaid
OH0931899Medicaid
OH0818177Medicare PIN
IN200142750Medicaid