Provider Demographics
NPI:1104244383
Name:ROSS, JARED LEVY (DO)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:LEVY
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8072
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-9123
Mailing Address - Fax:314-747-3338
Practice Address - Street 1:400 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1014
Practice Address - Country:US
Practice Address - Phone:314-362-9123
Practice Address - Fax:314-747-3338
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018008991207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services