Provider Demographics
NPI:1659564193
Name:ROSS, AMY SIMON (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SIMON
Last Name:ROSS
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Gender:
Credentials:MD
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Mailing Address - Street 1:4197 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3493
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:1425 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3491
Practice Address - Country:US
Practice Address - Phone:813-253-2635
Practice Address - Fax:813-254-7241
Is Sole Proprietor?:No
Enumeration Date:2007-08-18
Last Update Date:2025-03-21
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Provider Licenses
StateLicense IDTaxonomies
FLME100102207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121492800Medicaid