| David E Ross, Jr, Md,pc | |
|
1619 W 5th Ave Gary IN 46404-1506 | |
| (219) 886-4788 | |
| (219) 886-4106 |
| Full Name | David E Ross, Jr, Md,pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1619 W 5th Ave, Gary, Indiana |
| Authorized Official Name and Position | Nathaniel Ross (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2198864788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David E Ross, Jr, Md,pc Po Box 4787 Gary IN 46404-0787 Ph: (219) 886-4788 | David E Ross, Jr, Md,pc 1619 W 5th Ave Gary IN 46404-1506 Ph: (219) 886-4788 |
| NPI Number | 1407985971 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 05/17/2024 |
| Medicare PECOS PAC ID | 3870559966 |
|---|---|
| Medicare Enrollment ID | O20090810000207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407985971 | NPI | - | NPPES |
| 100212420A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Nathaniel T Ross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417942707 PECOS PAC ID: 6709808264 Enrollment ID: I20060119000500 |
| Provider Name | Jeanne M Kerr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790328094 PECOS PAC ID: 3173956281 Enrollment ID: I20191204000163 |
| Provider Name | Shavon Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992479042 PECOS PAC ID: 6709282387 Enrollment ID: I20210907002429 |
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