Basic Information
| Provider Information | |||||||||
| NPI: | 1902957111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11984 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352021984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514315800 | ||||||||
| FaxNumber: | 2514315810 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366024011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514333781 | ||||||||
| FaxNumber: | 2514333772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | MD11055 | AL | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 515-23094 | 01 | AL | BLUE CROSS PROV ID-WEST | OTHER | 515-14917 | 01 | AL | BLUE CROSS PROV ID-DAPHNE | OTHER | 510-31570 | 01 | AL | BLUE CROSS PROV ID-IMC | OTHER |