Provider Demographics
NPI:1871299495
Name:ROSS, JUSTIN STANLEY
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:STANLEY
Last Name:ROSS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 CARMONA CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2397
Mailing Address - Country:US
Mailing Address - Phone:909-768-2899
Mailing Address - Fax:
Practice Address - Street 1:1125 N. COLLEGE AVENUE, SLOT 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-713-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program