Provider Demographics
NPI:1437433083
Name:DREHER, ROSS
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:DREHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3970
Mailing Address - Country:US
Mailing Address - Phone:772-501-9911
Mailing Address - Fax:
Practice Address - Street 1:2727 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-9305
Practice Address - Country:US
Practice Address - Phone:772-501-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171WH0202X
FLD660720530830172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No172A00000XOther Service ProvidersDriver