Provider Demographics
NPI:1952690893
Name:ROSS, DAVID BYASA (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BYASA
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-619-4400
Mailing Address - Fax:918-660-3517
Practice Address - Street 1:4444 E 41ST ST STE 2B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-660-3517
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2021-04-02
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Provider Licenses
StateLicense IDTaxonomies
OK295002084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200472010AMedicaid
OK200472010AMedicaid
OK73-1042545OtherGROUP MEDICARE
OK73-1042545OtherGROUP BCBS
OK100732910-AOtherGROUP MEDICAID/SOONERCARE
OK100732910-GOtherGROUP MEDICAID/SOONERCARE
OK73-1042545OtherGROUP COMMUNITY CARE OF OKLAHOMA