Provider Demographics
NPI:1942200332
Name:ROSS, ROBERT R JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 403, BUILDING B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-485-3351
Practice Address - Fax:941-485-7677
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-06-15
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Provider Licenses
StateLicense IDTaxonomies
FLME0014723208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15577301OtherCITRUS HEALTH
FL4271860OtherAETNA PROVIDER #
FLP00466615OtherRAILROAD MEDICARE
FL06797OtherBCBS FL
FL344467OtherAVMED
FLD67107Medicare UPIN
FL4271860OtherAETNA PROVIDER #