Provider Demographics
NPI:1134195167
Name:ROSS, RYIA M (MD)
Entity type:Individual
Prefix:
First Name:RYIA
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:112 S HANLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3418
Mailing Address - Country:US
Mailing Address - Phone:314-863-2444
Mailing Address - Fax:314-863-2211
Practice Address - Street 1:112 S HANLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3418
Practice Address - Country:US
Practice Address - Phone:314-863-2444
Practice Address - Fax:314-863-2211
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-02-16
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Provider Licenses
StateLicense IDTaxonomies
MO105403208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207674219Medicaid