Provider Demographics
NPI:1972913069
Name:ROSS, EVAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:M
Last Name:ROSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1506 NE WILLIAMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6071
Mailing Address - Country:US
Mailing Address - Phone:541-383-3668
Mailing Address - Fax:541-383-4546
Practice Address - Street 1:1506 NE WILLIAMSON BLVD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6071
Practice Address - Country:US
Practice Address - Phone:541-383-3668
Practice Address - Fax:541-383-4546
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDP198503213ES0103X
KY00448213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201394010Medicaid
KY7100417980Medicaid
KYP01673048OtherRAILROAD MEDICARE
KY50111319OtherPASSPORT HEALTH PLAN
KY000001024410OtherANTHEM
KYP01673048OtherRAILROAD MEDICARE