Provider Demographics
NPI:1780671313
Name:ROSS, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 830605
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78283-0605
Mailing Address - Country:US
Mailing Address - Phone:210-222-0333
Mailing Address - Fax:210-928-4837
Practice Address - Street 1:7355 BARLITE BLVD
Practice Address - Street 2:STE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1342
Practice Address - Country:US
Practice Address - Phone:210-222-0333
Practice Address - Fax:210-928-4837
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121237502Medicaid
TX121237502Medicaid
E46923Medicare UPIN