Healthcare Provider Details

I. General information

NPI: 1336302223
Provider Name (Legal Business Name): JERMAINE COMPTON RALPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S PINELLAS AVE STE G
TARPON SPRINGS FL
34689-1950
US

IV. Provider business mailing address

1501 S PINELLAS AVE STE G
TARPON SPRINGS FL
34689-1950
US

V. Phone/Fax

Practice location:
  • Phone: 727-943-3405
  • Fax:
Mailing address:
  • Phone: 727-943-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number248527
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22919
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME 113296
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number22919
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number248527
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME 113296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: