Provider Demographics
NPI:1164494449
Name:ROSS, GEORGE GREGORY (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:GREGORY
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-835-1235
Mailing Address - Fax:850-835-4195
Practice Address - Street 1:281 STATE HIGHWAY 20 E
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-3929
Practice Address - Country:US
Practice Address - Phone:850-835-1235
Practice Address - Fax:850-835-4195
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043291207R00000X
FLME136715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine