Individual
ROSS ELTIDGE HAIRGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 EVERETT DR STE 400, KYLE, TX 78640-6147
(512) 295-1333
(512) 406-7327
Mailing address
6210 E HWY 290, AUSTIN, TX 78723-1142
(512) 483-9596
(512) 406-6216
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
Q4760
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
348622703
—
TX
Enumeration date
06/19/2013
Last updated
06/07/2021
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