Provider Demographics
NPI:1780210823
Name:STRAUGHAN, ROSS ELLIOTT
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:ELLIOTT
Last Name:STRAUGHAN
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 1:4280 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6034
Mailing Address - Country:US
Mailing Address - Phone:417-880-2117
Mailing Address - Fax:
Practice Address - Street 1:4280 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6034
Practice Address - Country:US
Practice Address - Phone:417-880-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program