Provider Demographics
NPI:1598766511
Name:ROBERT D. ROSS, MD (APMC)
Entity Type:Organization
Organization Name:ROBERT D. ROSS, MD (APMC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DICK
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-888-7771
Mailing Address - Street 1:1 HOLYLAND DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1055
Mailing Address - Country:US
Mailing Address - Phone:504-888-7771
Mailing Address - Fax:504-888-9388
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 430
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-888-7771
Practice Address - Fax:504-888-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10706R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5264OtherRAILROAD MEDICARE
LA1447358Medicaid
MS09016166Medicaid
MS09016166Medicaid
=========OtherTRICARE
LA5CD86Medicare PIN
DC5264OtherRAILROAD MEDICARE