Provider Demographics
NPI:1194027763
Name:JERABEK, ROSS WILLIAM
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:WILLIAM
Last Name:JERABEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2230
Mailing Address - Country:US
Mailing Address - Phone:828-253-3492
Mailing Address - Fax:
Practice Address - Street 1:1 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2230
Practice Address - Country:US
Practice Address - Phone:828-253-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist