Provider Demographics
NPI:1194700823
Name:ROSS, STEPHEN MARK (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380877
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0877
Mailing Address - Country:US
Mailing Address - Phone:941-979-5200
Mailing Address - Fax:941-979-5201
Practice Address - Street 1:6150 MANASOTA KEY RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-9253
Practice Address - Country:US
Practice Address - Phone:410-571-0350
Practice Address - Fax:410-571-7069
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8516261QR0200X
FLPMC1621261QP3300X
FLPMC1664261QP3300X
FL261QP3300X
FLPMC1756261QP3300X
FLME75401L2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262392700Medicaid
FL4213OtherHEALTH CARE CLINIC PERMIT
FLPMC1664OtherPAIN MANAGEMENT
35702LOtherMEDICARE PERSONAL PTAN
FLPMC1756OtherPAIN MANAGEMENT
FLFK751AOtherMEDICARE PTAN SAR PAIN INSTITUTE LLC
FL150492200863OtherHUMANA
FLHCC8516OtherAHCA RX FOR IMAGING
FLCO744OtherRX FOR IMAGING MEDICARE
FL213119OtherAMERIGROUP
FLPMC1148OtherPAIN MANAGEMENT CLINIC
FLV2822OtherBCBS
FLPMC1621OtherPAIN MANAGEMENT
FLPMC1148OtherPAIN MANAGEMENT CLINIC