Organization
DIANE E ROSS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE E ROSS MD (PRESIDENT)
(228) 896-3317
Entity
Organization
Contact information
Practice address
2160 E PASS ROAD, SUITE D, GULFPORT, MS 39507-3801
(228) 896-3317
(228) 896-3314
Mailing address
2160 E PASS ROAD, SUITE D, GULFPORT, MS 39507-3801
(228) 896-3317
(228) 896-3314
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
09562
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01121509
—
MS
Enumeration date
03/26/2008
Last updated
08/29/2014
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