Provider Demographics
NPI:1144350349
Name:VANDER NOOT, ROSS M (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:M
Last Name:VANDER NOOT
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 1:619 19TH ST S
Mailing Address - Street 2:OHB 251
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-1900
Mailing Address - Country:US
Mailing Address - Phone:205-975-7387
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:OHB 251
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-975-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127063207P00000X
AL28863207P00000X
ALMD.28863207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-92504OtherBCBS
AL111042Medicaid
AL1144350349OtherTRICARE SOUTH
AL103334Medicaid
AL102I930485Medicare PIN
AL1144350349OtherTRICARE SOUTH
ALP00682453Medicare PIN