Provider Demographics
NPI:1437287497
Name:ROSS, CHARLES ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
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 1:8727 TEMPLE TERRACE HWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-6700
Mailing Address - Country:US
Mailing Address - Phone:813-796-5400
Mailing Address - Fax:813-776-0079
Practice Address - Street 1:8727 TEMPLE TERRACE HWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-6700
Practice Address - Country:US
Practice Address - Phone:813-796-5400
Practice Address - Fax:813-776-0079
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96407207Q00000X, 207Q00000X
FLME 96407207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL132846OtherAMERICAN BOARD OF FAMILY MEDICINE
FLME96407OtherMEDICAL LICENSE
FL008257800Medicaid
FLAC872ZMedicare PIN
FL132846OtherAMERICAN BOARD OF FAMILY MEDICINE
FLAC872UMedicare PIN