Provider Demographics
NPI:1013367333
Name:CANUP, ROSS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:MICHAEL
Last Name:CANUP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:42D MEDICAL GROUP
Mailing Address - Street 2:300 S. TWINING ST. BLDG 760
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-5200
Mailing Address - Fax:
Practice Address - Street 1:42D MEDICAL GROUP
Practice Address - Street 2:300 S. TWINING ST. BLDG 760
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-5200
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2023-04-27
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Provider Licenses
StateLicense IDTaxonomies
VA0101263009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101263009OtherVIRGINIA MEDICAL LICENSE