Provider Demographics
NPI:1659395069
Name:ROSS, JEFFREY ALLAN (DPM MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:ROSS
Suffix:
Gender:M
Credentials:DPM MD
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Mailing Address - Street 1:ONE BAYLOR PLAZA
Mailing Address - Street 2:MS 390
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2309
Mailing Address - Country:US
Mailing Address - Phone:713-798-7851
Mailing Address - Fax:713-798-8911
Practice Address - Street 1:7200 CAMBRIDGE ST
Practice Address - Street 2:SUITE 6B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2309
Practice Address - Country:US
Practice Address - Phone:713-798-5700
Practice Address - Fax:713-798-8460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX0697213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1201OtherBOARD CERT
TXP00MP93Medicaid
TXP00MP93Medicaid
TXP00MP93Medicaid
TX8L27316Medicare PIN
T15637Medicare UPIN