Provider Demographics
NPI:1760472641
Name:ROSS, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-0062
Mailing Address - Country:US
Mailing Address - Phone:970-298-7578
Mailing Address - Fax:970-298-1809
Practice Address - Street 1:2635 N 7TH ST
Practice Address - Street 2:STE 4205
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8209
Practice Address - Country:US
Practice Address - Phone:970-298-2273
Practice Address - Fax:970-298-1809
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO24065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01240654Medicaid
COCE2624Medicare PIN
COD24381Medicare UPIN