Provider Demographics
NPI:1891756516
Name:ROSS, STEPHEN CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CRAIG
Last Name:ROSS
Suffix:
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 1:522 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6857
Mailing Address - Country:US
Mailing Address - Phone:314-567-5100
Mailing Address - Fax:314-567-3387
Practice Address - Street 1:522 N NEW BALLAS RD
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6857
Practice Address - Country:US
Practice Address - Phone:314-567-5100
Practice Address - Fax:314-567-3387
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9A31207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201725603Medicaid
MO23560OtherBLUE CROSS BLUE SHIELD
MOA12739OtherPHCS
MO320023OtherUNITED HEALTH CARE
MOA12739OtherMERCY
MOA12739OtherGREAT WEST
MO5783152OtherAETNA
MOA12739OtherCIGNA
MOA12739OtherMERCY
MOA12739OtherPHCS