Provider Demographics
NPI:1669629101
Name:ROSSO, RITCHIE OLIVER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RITCHIE
Middle Name:OLIVER
Last Name:ROSSO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2233
Mailing Address - Country:US
Mailing Address - Phone:432-333-6603
Mailing Address - Fax:432-333-8014
Practice Address - Street 1:4040 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-3301
Practice Address - Country:US
Practice Address - Phone:432-333-6603
Practice Address - Fax:432-333-8014
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106581207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology