Provider Demographics
NPI:1427116698
Name:ROSS, RANDALL E (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1830 BLAKE AVE
Mailing Address - Street 2:#202 ROARING FORK SURGICAL ASSOC
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601
Mailing Address - Country:US
Mailing Address - Phone:970-945-6533
Mailing Address - Fax:970-945-3945
Practice Address - Street 1:1830 BLAKE AVE
Practice Address - Street 2:ROARING FORK SURGICAL ASSOC
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601
Practice Address - Country:US
Practice Address - Phone:970-945-6533
Practice Address - Fax:970-945-3945
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-05-19
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Provider Licenses
StateLicense IDTaxonomies
COCO33497208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
841409708002OtherRMHMO
1526353OtherUMWA
CO6640OtherBCBS
COCO33497OtherRR MEDICARE
P00175799OtherRR PIN
CO01334978Medicaid
F80214Medicare UPIN
COCO33497OtherRR MEDICARE