Provider Demographics
NPI:1154847580
Name:DAVIS FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:DAVIS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-360-4150
Mailing Address - Street 1:5556 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-1007
Mailing Address - Country:US
Mailing Address - Phone:850-360-4150
Mailing Address - Fax:850-360-4155
Practice Address - Street 1:5556 BROWN ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1007
Practice Address - Country:US
Practice Address - Phone:850-360-4150
Practice Address - Fax:850-360-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR7779AOtherFLORIDA MEDICARE