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Individual

RANDOLPH J ROSS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2 MORGANS LNDG, HATTIESBURG, MS 39402-8722
(601) 268-0258
Mailing address
2 MORGANS LNDG, HATTIESBURG, MS 39402-8722
(601) 268-0258

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
08965
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00011237
MS
05
1311634
LA
01
1558974
AMERICAN ADMIN GROUP
MS
01
340001326
RAILROAD MEDICARE
MS
Enumeration date
08/29/2006
Last updated
08/03/2022
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