Provider Demographics
NPI:1962403972
Name:ROSS, SIDNEY OSBORN (MD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:OSBORN
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 PICARDY AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3676
Mailing Address - Country:US
Mailing Address - Phone:225-763-4820
Mailing Address - Fax:225-763-4819
Practice Address - Street 1:8595 PICARDY AVE STE 420
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3676
Practice Address - Country:US
Practice Address - Phone:225-763-4820
Practice Address - Fax:225-763-4819
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03360R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1192317Medicaid
LAD80526Medicare UPIN