Provider Demographics
NPI:1902981764
Name:ROSS, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8575 E PRINCESS DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-778-9000
Mailing Address - Fax:480-778-9001
Practice Address - Street 1:8575 E PRINCESS DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-778-9000
Practice Address - Fax:480-778-9001
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ26307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
63116Medicare ID - Type Unspecified
G67990Medicare UPIN