Individual
MARY ELIZABETH ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637
(309) 624-4945
(309) 624-9848
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-4945
(309) 624-9848
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
036.122072
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036122072
—
IL
05
—
2534850
—
OH
Enumeration date
09/27/2005
Last updated
07/21/2022
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