Provider Demographics
NPI:1508228750
Name:ROSS, JAMES HOWARD BRODY
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HOWARD BRODY
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43097 WOODWARD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5043
Mailing Address - Country:US
Mailing Address - Phone:248-334-4505
Mailing Address - Fax:248-253-0347
Practice Address - Street 1:43097 WOODWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-5043
Practice Address - Country:US
Practice Address - Phone:248-334-4505
Practice Address - Fax:248-253-0347
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138777207V00000X
NJ25MA11833500207VF0040X
MI4301512511207VF0040X, 207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program