Provider Demographics
NPI:1033137997
Name:DAVIES, LAURIE K (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:K
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-3441
Mailing Address - Fax:352-392-7029
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-3441
Practice Address - Fax:352-392-7029
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41202207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068498800Medicaid
FL068498800Medicaid
68324ZMedicare PIN
D57862Medicare UPIN