Provider Demographics
NPI:1780602482
Name:ROSS, JOSEPH JOHN (MD,FACS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3979
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-3979
Mailing Address - Country:US
Mailing Address - Phone:352-795-6622
Mailing Address - Fax:352-563-2598
Practice Address - Street 1:295 SE HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429
Practice Address - Country:US
Practice Address - Phone:352-795-6622
Practice Address - Fax:352-563-2598
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052548207W00000X, 2082S0099X, 2086S0122X
FLME613952082S0099X, 2086S0122X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCE659YOtherMEDICARE PTAN
FL010029800Medicaid
OH0644297OtherMEDICARE PTAN
OH0757668Medicaid
OH0757668Medicaid