Provider Demographics
NPI:1497831044
Name:ROSS, ROBERT FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANCIS
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 1:601 COURT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2160
Mailing Address - Country:US
Mailing Address - Phone:209-257-0686
Mailing Address - Fax:209-257-0197
Practice Address - Street 1:601 COURT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2160
Practice Address - Country:US
Practice Address - Phone:209-257-0686
Practice Address - Fax:209-257-0197
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG6037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A57423Medicare UPIN
ZZZ21122ZMedicare ID - Type Unspecified