Provider Demographics
NPI:1982172029
Name:ROSS, WILLIAM LANDON (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LANDON
Last Name:ROSS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W MEMORIAL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1508
Mailing Address - Country:US
Mailing Address - Phone:405-751-0020
Mailing Address - Fax:405-751-0009
Practice Address - Street 1:3705 W MEMORIAL RD STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1508
Practice Address - Country:US
Practice Address - Phone:405-751-0020
Practice Address - Fax:405-751-0009
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2973363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPENDINGOtherPENDING