Provider Demographics
NPI:1730400615
Name:JAY H ROSS MD PA
Entity type:Organization
Organization Name:JAY H ROSS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-789-5711
Mailing Address - Street 1:35080 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1925
Mailing Address - Country:US
Mailing Address - Phone:727-789-5711
Mailing Address - Fax:727-789-4098
Practice Address - Street 1:35080 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1925
Practice Address - Country:US
Practice Address - Phone:727-789-5711
Practice Address - Fax:727-789-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty