Provider Demographics
NPI:1477553618
Name:ROSS, DONALD ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ANDREW
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 1:2900 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8475
Mailing Address - Country:US
Mailing Address - Phone:541-779-1672
Mailing Address - Fax:541-618-9434
Practice Address - Street 1:2900 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8475
Practice Address - Country:US
Practice Address - Phone:541-779-1672
Practice Address - Fax:541-618-9434
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD22175207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134474Medicaid
OR134474Medicaid
E42399Medicare UPIN