Provider Demographics
NPI:1942295563
Name:ROSS, GERALD ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALAN
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10000 SW INNOVATION WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2111
Mailing Address - Country:US
Mailing Address - Phone:772-345-5280
Mailing Address - Fax:772-345-5274
Practice Address - Street 1:10000 SW INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2111
Practice Address - Country:US
Practice Address - Phone:772-345-5280
Practice Address - Fax:772-345-5274
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8788207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267126300Medicaid
FL267126300Medicaid
FL51949AMedicare ID - Type Unspecified