Provider Demographics
NPI:1114951506
Name:ROSS, ROBIN DEMI (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:DEMI
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 E CACTUS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4192
Mailing Address - Country:US
Mailing Address - Phone:480-534-8080
Mailing Address - Fax:480-534-8081
Practice Address - Street 1:4835 E CACTUS RD STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4192
Practice Address - Country:US
Practice Address - Phone:480-534-8080
Practice Address - Fax:480-534-8081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52811207W00000X, 207WX0107X
MI4301055805207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ442209Medicaid
MI0985921OtherHEALTH PLUS OF MICHIGAN
MI104101440Medicaid
MIC6553OtherM CARE
MIC6553OtherM CARE
MIC6553OtherM CARE