Organization
DIANE ROSS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE E ROSS MD (OWNER)
(228) 896-3317
Entity
Organization
Contact information
Practice address
749 OAKLEIGH AVE, GULFPORT, MS 39507-3809
(228) 896-3317
(228) 896-3314
Mailing address
2160 E PASS RD STE D, GULFPORT, MS 39507-3801
(228) 896-3317
(228) 896-3314
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010874
—
MS
Enumeration date
04/23/2015
Last updated
04/23/2015
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