Most Relevant Information
Provider Data
| NPI Number: | 1003586934 |
| Provider Name: | DERRIS ROSS |
| Entity Type: | Individual |
| Taxonomy Code: | 261QM0801X |
| Specialty: | Clinic/Center |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/13/2021 |
| Last Updated: | 09/13/2021 |
Provider Practice Location
3939 N ARLINGTON AVE
INDIANAPOLIS
IN
462264816
Practice Location Phone/Fax
| Phone: | 4632227550 |
| Fax: |
Provider Mailing Location
8901 E 42ND ST
INDIANAPOLIS
IN
462265515
Provider Mailing Phone/Fax
| Phone: | 4632227550 |
| Fax: |