Provider Demographics
NPI:1356301634
Name:ROS, JOSE LARRABASTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LARRABASTER
Last Name:ROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:IGNACIO
Other - Last Name:ROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3245 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5251
Mailing Address - Country:US
Mailing Address - Phone:910-937-0008
Mailing Address - Fax:910-937-0098
Practice Address - Street 1:3245 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5251
Practice Address - Country:US
Practice Address - Phone:910-937-0008
Practice Address - Fax:910-937-0098
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913181Medicaid
NC2328801Medicare ID - Type Unspecified
NCG62410Medicare UPIN