Provider Demographics
NPI:1538135843
Name:ROSS, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1206
Practice Address - Country:US
Practice Address - Phone:952-993-8250
Practice Address - Fax:952-993-8276
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN44478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN336877700Medicaid