Individual
THEODORA SUZANNE ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5323 HARRY HINES BLVD., DALLAS, TX 75390-7208
(214) 645-4673
(214) 645-2610
Mailing address
P.O. BOX 845347, DALLAS, TX 75284-5347
(214) 645-4673
(214) 645-2610
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301075061
MI
207R00000X
Internal Medicine Physician
P2161
TX
207RH0000X
Hematology (Internal Medicine) Physician
4301075061
MI
207RH0003X
Hematology & Oncology Physician
Primary
P2161
TX
207RX0202X
Medical Oncology Physician
4301075061
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
295867001
—
TX
05
—
4129067
—
MI
01
—
TXB147854
MEDICARE ID/TYPE UNSPECIFIED
TX
Enumeration date
11/16/2006
Last updated
10/15/2014
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