Provider Demographics
NPI:1912959594
Name:ROSS, DAVID LECOMPTE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LECOMPTE
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 534595
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4595
Mailing Address - Country:US
Mailing Address - Phone:321-725-5050
Mailing Address - Fax:321-676-2765
Practice Address - Street 1:1048 HARVIN WAY
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3229
Practice Address - Country:US
Practice Address - Phone:321-636-2111
Practice Address - Fax:321-636-7180
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000497207RX0202X
FLME90807207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1912959594Medicaid
FL276847000Medicaid
MO2008000497OtherMO LICENSE
FL68035OtherBCBS
FLME90807OtherMEDICAL LICENSE
MO1912959594Medicaid