Provider Demographics
NPI:1366019531
Name:JASON ROOS DO A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JASON ROOS DO A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:VALLEY ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-720-6659
Mailing Address - Street 1:805 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6162
Practice Address - Country:US
Practice Address - Phone:509-720-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty