Provider Demographics
NPI:1467673251
Name:ROSS, DORIS GWENDOLYN (MD)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:GWENDOLYN
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:D
Other - Middle Name:GWENDOLYN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4998
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4998
Mailing Address - Country:US
Mailing Address - Phone:808-325-3255
Mailing Address - Fax:808-325-3255
Practice Address - Street 1:73 4434 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-325-3255
Practice Address - Fax:808-325-3255
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD81292084P0800X
HIMD 81292084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000007161OtherHMSA
HI00735801Medicaid
HI2881OtherALOHA CARE
HI0000007161OtherHMSA
HI00735801Medicaid