Provider Demographics
NPI:1376700229
Name:REGA, ROSS JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JOSEPH
Last Name:REGA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8052 ROYAL BIRKDALE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2534
Mailing Address - Country:US
Mailing Address - Phone:941-907-1127
Mailing Address - Fax:941-907-0731
Practice Address - Street 1:8052 ROYAL BIRKDALE CIR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2534
Practice Address - Country:US
Practice Address - Phone:941-907-1127
Practice Address - Fax:941-907-0731
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00114000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery