Provider Demographics
NPI:1699339598
Name:ROSS, SPENCER GREGORY
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:GREGORY
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 READ LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2367
Mailing Address - Country:US
Mailing Address - Phone:504-246-9860
Mailing Address - Fax:504-246-9861
Practice Address - Street 1:7060 READ LN STE 200
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2367
Practice Address - Country:US
Practice Address - Phone:504-246-9860
Practice Address - Fax:504-246-9861
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator