Individual
DR. KELLY D ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
140 W 4TH ST STE 1, SAINT ANSGAR, IA 50472-1352
(641) 736-4401
(641) 736-4407
Mailing address
140 W 4TH ST STE 1, PO BOX 249, SAINT ANSGAR, IA 50472-1352
(641) 736-4401
(641) 736-4407
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23076
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0213892
—
IA
01
—
07000
WELLMARK
IA
Enumeration date
09/29/2006
Last updated
05/19/2021
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