Provider Demographics
NPI:1639139751
Name:DAVIS, MICHAEL F (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
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Other - Last Name:
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Mailing Address - Street 1:61 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:SUITE 3811
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5981
Mailing Address - Country:US
Mailing Address - Phone:386-986-4919
Mailing Address - Fax:386-986-4922
Practice Address - Street 1:200 E BROWN ST
Practice Address - Street 2:POCONO KIDS PEDIATRICS
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-476-3585
Practice Address - Fax:570-421-9014
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-10-10
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Provider Licenses
StateLicense IDTaxonomies
FLOS9939208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280132900Medicaid
I40838Medicare UPIN