Provider Demographics
NPI:1811004757
Name:INLAND EMPIRE DERMATOLOGY, PS
Entity Type:Organization
Organization Name:INLAND EMPIRE DERMATOLOGY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-921-7884
Mailing Address - Street 1:312 N MULLAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6845
Mailing Address - Country:US
Mailing Address - Phone:509-921-7884
Mailing Address - Fax:509-921-8038
Practice Address - Street 1:312 N MULLAN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6845
Practice Address - Country:US
Practice Address - Phone:509-921-7884
Practice Address - Fax:509-921-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001816207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3850ROOtherASURIS
7853434OtherAETNA
WA3850ROOtherASURIS
WAH78123Medicare UPIN