Provider Demographics
NPI:1689666810
Name:DAVIS, DEAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:G
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 1:4714 N ARMENIA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2603
Mailing Address - Country:US
Mailing Address - Phone:813-341-3223
Mailing Address - Fax:813-870-0334
Practice Address - Street 1:4714 N ARMENIA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2603
Practice Address - Country:US
Practice Address - Phone:813-341-3223
Practice Address - Fax:813-870-0334
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0082536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH39749Medicare UPIN
FL01690YMedicare ID - Type Unspecified