Organization
FRED H ROSS, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED HENRY ROSS M.D. (OWNER)
(850) 878-8509
Entity
Organization
Contact information
Practice address
1612 W PLAZA DR, TALLAHASSEE, FL 32308-5324
(850) 878-8509
Mailing address
1612 W PLAZA DR, TALLAHASSEE, FL 32308-5324
(850) 878-8509
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME 44955
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20066
FLORIDA BLUE
FL
Enumeration date
12/29/2016
Last updated
12/29/2016
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