Provider Demographics
NPI:1659564193
Name:ROSS, AMY SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SIMON
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1528
Mailing Address - Fax:813-255-2818
Practice Address - Street 1:4197 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3493
Practice Address - Country:US
Practice Address - Phone:727-786-3810
Practice Address - Fax:727-786-3855
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2022-10-08
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Provider Licenses
StateLicense IDTaxonomies
FLME100102207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110113800Medicaid