Individual
JEFFREY D. ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
427 HWY 51 NORTH, BROOKHAVEN, MS 39601-2600
(601) 833-0541
Mailing address
200 CORPORATE BLVD., SUITE 201, LAFAYETTE, LA 70508
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
11415
MS
208M00000X
Hospitalist Physician
Primary
11415
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124738
—
MS
01
—
4270448312B
BLUE CROSS
MS
01
—
MS11415M
MS STATE LICENSE
MS
Enumeration date
06/15/2006
Last updated
07/20/2010
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