Provider Demographics
NPI:1235119124
Name:ROSS, JOSE AUGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:AUGUSTO
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 1:2725 MAYAGUANA CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6365
Mailing Address - Country:US
Mailing Address - Phone:941-313-9009
Mailing Address - Fax:941-623-9532
Practice Address - Street 1:18338 MURDOCK CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1029
Practice Address - Country:US
Practice Address - Phone:941-313-9009
Practice Address - Fax:941-623-9532
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70208207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110921700Medicaid
FLAC203WMedicare PIN
FLD 89975Medicare UPIN
FL276166100Medicaid
FLAC203YMedicare PIN