Provider Demographics
NPI:1114165701
Name:DAVIES, PAUL JOHN (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:DAVIES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10738 SW 88TH ST
Mailing Address - Street 2:APT. K-7
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1468
Mailing Address - Country:US
Mailing Address - Phone:305-274-0412
Mailing Address - Fax:
Practice Address - Street 1:3641 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4205
Practice Address - Country:US
Practice Address - Phone:305-854-0302
Practice Address - Fax:305-854-0308
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3225512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000720000Medicaid