Provider Demographics
NPI:1386633428
Name:DAVILA, VIRGIL A (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:A
Last Name:DAVILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7154
Mailing Address - Country:US
Mailing Address - Phone:407-381-7387
Mailing Address - Fax:407-636-7821
Practice Address - Street 1:7416 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7154
Practice Address - Country:US
Practice Address - Phone:407-381-7387
Practice Address - Fax:407-636-7821
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66010207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379767800Medicaid
FL379767800Medicaid
G30962Medicare UPIN