Provider Demographics
NPI:1508276924
Name:ROSS, TAMAREAL (MD)
Entity Type:Individual
Prefix:
First Name:TAMAREAL
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9490 E STATE ROUTE 350
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-6509
Mailing Address - Country:US
Mailing Address - Phone:816-256-4089
Mailing Address - Fax:816-731-1548
Practice Address - Street 1:9490 E STATE ROUTE 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-6509
Practice Address - Country:US
Practice Address - Phone:816-256-4089
Practice Address - Fax:816-731-1548
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-48005207Q00000X
TXR3420207Q00000X
390200000X
MO2023010416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program