Provider Demographics
NPI:1780779546
Name:ROSS, JANET M (PA-C)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6301 GASTON AVE STE 100W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6273
Mailing Address - Country:US
Mailing Address - Phone:214-827-3610
Mailing Address - Fax:214-821-4017
Practice Address - Street 1:6301 GASTON AVE STE 100W
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-6273
Practice Address - Country:US
Practice Address - Phone:214-827-3610
Practice Address - Fax:214-821-4017
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06729363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140060OtherGROUP PTAN
TXTXB140060OtherGROUP PTAN