Individual
LISA RENE ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
214 14TH AVE SW, SIDNEY, MT 59270-3521
(406) 488-2100
(406) 488-2125
Mailing address
216 14TH AVE SW, SIDNEY, MT 59270-3519
(406) 488-2577
(406) 488-2580
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
34661
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000092716
BCBS PIN
MT
01
—
0150917
MDCD PIN
MT
01
—
10978
STATE LICENSE
MT
01
—
122154000
MDCD PIN
WY
Enumeration date
08/16/2005
Last updated
11/12/2020
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