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
State | License ID | Taxonomies |
---|---|---|
FL | ME0026479 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |