Male or Other

Dr. Ross M. Canup M.D.

Family Medicine Physician in Maxwell Afb, AL(View on Map)

Full Name

Dr. Ross Michael Canup M.D.

NPI Number

1013367333

NPI Type

Individual Provider

Gender

Male

Enumeration Date

06/17/2016

Specialties

(Taxonomies)

Code

207Q00000X

Primary Taxonomy

Yes

Licenses

State

Virginia

License Number

0101263009

Contact
Information

Purpose

Mailing
Location

Address

42D MEDICAL GROUP
42D MEDICAL GROUP

City

Maxwell Afb
Maxwell Afb

State

AL
AL

Postal Code

36112-6027
36112-6027

Country

US
US

Telephone Number

(334) 953-5200
(334) 953-5200

Identifiers

Identifier

0101263009

Identifier State

Unknown

Identifier Issuer

VIRGINIA MEDICAL LICENSE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 04/27/2023

Provider Address

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