Provider Demographics
NPI:1013177484
Name:ROSS, BENJAMIN W (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:W
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-1735
Mailing Address - Country:US
Mailing Address - Phone:563-568-3449
Mailing Address - Fax:
Practice Address - Street 1:105 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-1735
Practice Address - Country:US
Practice Address - Phone:563-568-3449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine