Provider Demographics
NPI:1376632521
Name:DAVIS, CLIFFORD R (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 UNIVERSITY SQUARE DR
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:813-254-4597
Practice Address - Street 1:2700 UNIVERSITY SQUARE DR
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-251-5822
Practice Address - Fax:813-254-4597
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME964402085R0202X
FLME 964402085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL118762Medicaid
FL278179400Medicaid
FLAE112YMedicare PIN
FLP00420189Medicare PIN
FLAE112SMedicare PIN
FLP00699790Medicare PIN
FLP00831950Medicare PIN
FL278179400Medicaid
AL118762Medicaid