Individual
DR. IAN ROBERT ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
1218 KRAFT ST, SAINT LOUIS, MO 63139-3710
(423) 863-9004
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD464154
PA
208D00000X
General Practice Physician
2015012494
MO
208M00000X
Hospitalist Physician
2015012494
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IL
Enumeration date
06/25/2013
Last updated
09/30/2021
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