Provider Demographics
NPI:1396240040
Name:ROSS, NICHOLAS GUY (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GUY
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3142
Mailing Address - Country:US
Mailing Address - Phone:941-357-5550
Mailing Address - Fax:941-792-7152
Practice Address - Street 1:4401 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3142
Practice Address - Country:US
Practice Address - Phone:941-357-5550
Practice Address - Fax:941-792-7152
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS17369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program