Provider Demographics
NPI:1972061513
Name:ROSS, PHILIP JOSEPH II (PA-S)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOSEPH
Last Name:ROSS
Suffix:II
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75332 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-2511
Mailing Address - Country:US
Mailing Address - Phone:360-560-2045
Mailing Address - Fax:
Practice Address - Street 1:527 2ND ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-8486
Practice Address - Country:US
Practice Address - Phone:360-225-8911
Practice Address - Fax:360-225-8527
Is Sole Proprietor?:No
Enumeration Date:2019-03-02
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
WAPA60971774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program