Provider Demographics
NPI:1861634917
Name:BLAGG, ROSS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:MICHAEL
Last Name:BLAGG
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 1:8405 BENT TREE ROAD
Mailing Address - Street 2:APT 2111
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:801-557-9040
Mailing Address - Fax:
Practice Address - Street 1:7700 CAT HOLLOW DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-244-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9581208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery