Provider Demographics
NPI:1922164714
Name:ROSS, HELEN R (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1890 E FLORENCE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5642
Practice Address - Country:US
Practice Address - Phone:520-374-2960
Practice Address - Fax:520-374-2961
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AZ34602207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ417695Medicaid
NY3K2291Medicare UPIN
AZZ131414Medicare PIN
AZ417695Medicaid
AZZ127970Medicare PIN
AZZ127969Medicare PIN