Provider Demographics
NPI:1316947138
Name:ROSS, DAVID BENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BENNETT
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6100 W 96TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6005
Mailing Address - Country:US
Mailing Address - Phone:317-715-1800
Mailing Address - Fax:317-715-6200
Practice Address - Street 1:3500 SOUTH LAFOUNTAIN ST
Practice Address - Street 2:RADIATION THERAPY
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46904-9011
Practice Address - Country:US
Practice Address - Phone:765-453-8571
Practice Address - Fax:765-453-8637
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01029769A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN149720KMedicare PIN
E05211Medicare UPIN