MEDICARE: JENNIFER ROSS COMPTIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	20-362	WI
2	390200000X	Student in an Organized Health Care Education/Training Program		FL
3	207R00000X	Internal Medicine Physician	R81100	AZ

General Provider Information

NPI Number	:	1528639317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROSS COMPTIS MD

Provider Business Mailing Address
First Line	:	165 NW 96TH TER APT 3-305
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 N 108TH AVE STE 142
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-5467
Country	:	US
Telephone Number	:	623-322-1145
Fax Number	:	623-466-9552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	04/22/2025

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