Provider Demographics
NPI:1023349313
Name:JOHN K ROSS, MD PC
Entity type:Organization
Organization Name:JOHN K ROSS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-504-7781
Mailing Address - Street 1:910 SW HIGHWAY 97
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-9247
Mailing Address - Country:US
Mailing Address - Phone:541-475-1193
Mailing Address - Fax:541-475-1195
Practice Address - Street 1:910 SW HIGHWAY 97
Practice Address - Street 2:SUITE 104
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9247
Practice Address - Country:US
Practice Address - Phone:541-475-1193
Practice Address - Fax:541-475-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR35733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty