Healthcare Provider Details

I. General information

NPI: 1912959594
Provider Name (Legal Business Name): DAVID LECOMPTE ROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 HARVIN WAY
ROCKLEDGE FL
32955-3229
US

IV. Provider business mailing address

PO BOX 100045
ATLANTA GA
30348-0045
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-2111
  • Fax: 321-636-7180
Mailing address:
  • Phone: 321-725-5050
  • Fax: 321-676-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME90807
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2008000497
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: