Provider Demographics
NPI:1871567099
Name:SHIPP, ROSS FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:FRANKLIN
Last Name:SHIPP
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 1:301 RICHLAND WEST CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7932
Mailing Address - Country:US
Mailing Address - Phone:254-756-7091
Mailing Address - Fax:254-754-2666
Practice Address - Street 1:301 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7932
Practice Address - Country:US
Practice Address - Phone:254-756-7091
Practice Address - Fax:254-754-2666
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BM492OtherBCBS
TX115476702Medicaid
TX115476704Medicaid
TX115476704Medicaid
TX8BM492OtherBCBS
TXSH088E956Medicare ID - Type Unspecified