Provider Demographics
NPI:1235328998
Name:CHRISTOPHER M DAVEY MD PA
Entity Type:Organization
Organization Name:CHRISTOPHER M DAVEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-321-1234
Mailing Address - Street 1:2191 9TH AVE N
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7146
Mailing Address - Country:US
Mailing Address - Phone:727-321-1234
Mailing Address - Fax:727-827-2966
Practice Address - Street 1:2191 9TH AVE N
Practice Address - Street 2:SUITE 115
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7146
Practice Address - Country:US
Practice Address - Phone:727-321-1234
Practice Address - Fax:727-827-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL732OtherMEDICARE PTAN
AL732OtherMEDICARE PTAN
FL23021Medicare PIN