Individual
MR. BLAINE M ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2735 SILVER CREEK ROAD, BULLHEAD CITY, AZ 86442
(928) 763-2273
Mailing address
PO BOX 7096, STOCKTON, CA 95267
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
32191
AZ
207LP2900X
Pain Medicine (Anesthesiology) Physician
32191
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
986789
AHCCCS
AZ
01
—
AZ0156280
BCBS OF ARIZONA
AZ
01
—
P00376172
RAILROAD MEDICARE
AZ
Enumeration date
06/06/2006
Last updated
10/31/2007
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