Provider Demographics
NPI:1003238312
Name:ROSS, DANIEL LEON JR (NP-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEON
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 W ORANGE GROVE RD UNIT A16
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7711
Mailing Address - Country:US
Mailing Address - Phone:520-909-3844
Mailing Address - Fax:520-308-5511
Practice Address - Street 1:600 W ORANGE GROVE RD UNIT A16
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7711
Practice Address - Country:US
Practice Address - Phone:520-909-3844
Practice Address - Fax:520-308-5511
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5256363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily