Provider Demographics
NPI:1851497382
Name:ROSS, ROBERT FICKLIN (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FICKLIN
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0550
Mailing Address - Country:US
Mailing Address - Phone:606-796-3029
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:927 KENTON STATION DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9617
Practice Address - Country:US
Practice Address - Phone:606-759-0433
Practice Address - Fax:606-759-0058
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64253610Medicaid
KY000000052212OtherANTHEM
KY000000052212OtherANTHEM
KY1796601Medicare ID - Type Unspecified