Provider Demographics
NPI:1013974484
Name:ROH, RICHARD ALVIN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALVIN
Last Name:ROH
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 8159
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0159
Mailing Address - Country:US
Mailing Address - Phone:251-300-2197
Mailing Address - Fax:251-414-5809
Practice Address - Street 1:150 SOUTH INGLESIDE
Practice Address - Street 2:STE 6
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-928-1222
Practice Address - Fax:251-928-2398
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000045346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045346Medicaid
C74981Medicare UPIN
AL000045346Medicare ID - Type Unspecified