Basic Information
| Provider Information | |||||||||
| NPI: | 1912959594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LECOMPTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 534595 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303534595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217255050 | ||||||||
| FaxNumber: | 3216762765 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329552827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216362111 | ||||||||
| FaxNumber: | 3216367180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 2008000497 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | ME90807 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2008000497 | 01 | MO | MO LICENSE | OTHER | ME90807 | 01 | FL | MEDICAL LICENSE | OTHER | 68035 | 01 | FL | BCBS | OTHER | 1912959594 | 05 | MO | MEDICAID | 276847000 | 05 | FL | MEDICAID |