Individual
JOHNNY SHANE ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST BLDG 35, TEMPLE, TX 76508-4200
(254) 724-2111
(512) 263-4506
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J6036
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0479743 02
—
TX
01
—
142726600
US DEPARTMENT OF LABOR
—
01
—
J6036
TX LICENSURE MEDICAL BOARD
TX
Enumeration date
08/30/2006
Last updated
10/23/2024
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