Basic Information
| Provider Information | |||||||||
| NPI: | 1518986363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3725 KINGFISHER LN | ||||||||
| Address2: | |||||||||
| City: | TERRELL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286829759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283263809 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2890 S LOOKOUT ST | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286109528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283263809 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14526 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 73305 | 01 | NC | BCBS - CLAREMONT | OTHER | AR2121616 | 01 | NC | DEA - NC | OTHER | 8973305 | 05 | NC | MEDICAID |