Provider Demographics
NPI:1295207850
Name:DAVIS, ERIC W
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7481 W OAKLAND PARK BLVD STE 302G
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4961
Mailing Address - Country:US
Mailing Address - Phone:954-249-0334
Mailing Address - Fax:954-451-5038
Practice Address - Street 1:7481 W OAKLAND PARK BLVD STE 302G
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4961
Practice Address - Country:US
Practice Address - Phone:954-497-3020
Practice Address - Fax:954-451-5038
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver