Provider Demographics
NPI:1063056752
Name:BINFORD, ROSS KAHAN (PA)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:KAHAN
Last Name:BINFORD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17402 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:HAVILAND
Mailing Address - State:KS
Mailing Address - Zip Code:67059-7820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1102 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4139
Practice Address - Country:US
Practice Address - Phone:785-238-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant