Provider Demographics
NPI:1346463189
Name:ROSS, ROBERT LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3201 WILSHIRE BOULEVARD
Mailing Address - Street 2:STE. 306
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2335
Mailing Address - Country:US
Mailing Address - Phone:310-829-6010
Mailing Address - Fax:310-829-5196
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:STE. 306
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:310-829-6010
Practice Address - Fax:310-829-5196
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC362672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87841Medicare UPIN