Provider Demographics
NPI:1528037256
Name:ROSS, DANIEL E (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 AIRPORT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-438-1136
Mailing Address - Fax:850-438-1148
Practice Address - Street 1:1110 AIRPORT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-438-1136
Practice Address - Fax:850-438-1148
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S97232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPPLIEDMedicaid
FLAPPLIEDMedicaid
I59105Medicare UPIN
FLAPPLIEDMedicare UPIN