Provider Demographics
NPI:1043283948
Name:DAVIS, CLINTON BERTRAND II (MD)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:BERTRAND
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 4TH STREET NORTH
Mailing Address - Street 2:ALL FLORIDA ORTHOPAEDIC ASSOCIATES
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3802
Mailing Address - Country:US
Mailing Address - Phone:727-527-5272
Mailing Address - Fax:727-522-7412
Practice Address - Street 1:4600 4TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3802
Practice Address - Country:US
Practice Address - Phone:727-527-5272
Practice Address - Fax:727-522-7412
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53370207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9968OtherMEDICARE
FL049362700Medicaid
FL049362700Medicaid