Individual
DR. ROSS MICHAEL CANUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
42D MEDICAL GROUP, 300 S. TWINING ST. BLDG 760, MAXWELL AFB, AL 36112-6027
(334) 953-5200
(334) 953-8607
Mailing address
42D MEDICAL GROUP, 300 S. TWINING ST. BLDG 760, MAXWELL AFB, AL 36112-6027
(334) 953-5200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101263009
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101263009
VIRGINIA MEDICAL LICENSE
—
Enumeration date
06/17/2016
Last updated
04/27/2023
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