Provider Demographics
NPI:1457332819
Name:DAVIS, VALERIE G (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:G
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:504 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7319
Mailing Address - Country:US
Mailing Address - Phone:386-423-2218
Mailing Address - Fax:386-427-0980
Practice Address - Street 1:504 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7319
Practice Address - Country:US
Practice Address - Phone:386-423-2218
Practice Address - Fax:386-427-0980
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051662207NS0135X
GA54808207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047966700Medicaid
FL047966700Medicaid
FLD51115Medicare UPIN