Provider Demographics
NPI:1083802813
Name:BARRY L DAVIS MD PA
Entity Type:Organization
Organization Name:BARRY L DAVIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-391-1666
Mailing Address - Street 1:951 NW 13TH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-391-1666
Mailing Address - Fax:561-391-0571
Practice Address - Street 1:951 NW 13TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2359
Practice Address - Country:US
Practice Address - Phone:561-391-1666
Practice Address - Fax:561-391-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty