Provider Demographics
NPI:1558472233
Name:DAVIS, SANFORD I (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:I
Last Name:DAVIS
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 1:7899 TALAVERA PL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-4322
Mailing Address - Country:US
Mailing Address - Phone:561-498-3248
Mailing Address - Fax:561-498-1216
Practice Address - Street 1:7899 TALAVERA PL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-4322
Practice Address - Country:US
Practice Address - Phone:561-498-3248
Practice Address - Fax:561-498-1216
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00314792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64460Medicare ID - Type Unspecified