Provider Demographics
NPI:1932100799
Name:ROSS, ROBERT DICK (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DICK
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 1:1 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10706R207W00000X
MS14895207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180044862OtherRAILROAD MEDICARE
LA1997536Medicaid
MS00122695Medicaid
LA1997536Medicaid
MS00122695Medicaid
180044862OtherRAILROAD MEDICARE