Provider Demographics
NPI:1114211786
Name:BIEDERMAN, ROSS ELDON (DPM)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:ELDON
Last Name:BIEDERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WYOMING STREET
Mailing Address - Street 2:
Mailing Address - City:JUNE LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93529
Mailing Address - Country:US
Mailing Address - Phone:760-648-1017
Mailing Address - Fax:760-648-1017
Practice Address - Street 1:140 WYOMING STREET
Practice Address - Street 2:
Practice Address - City:JUNE LAKE
Practice Address - State:CA
Practice Address - Zip Code:93529
Practice Address - Country:US
Practice Address - Phone:760-648-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2118213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery