Provider Demographics
NPI:1770502601
Name:DAVIS, MITCHELL N (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5431 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4639
Mailing Address - Country:US
Mailing Address - Phone:954-344-2522
Mailing Address - Fax:954-344-9189
Practice Address - Street 1:1447 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3164
Practice Address - Country:US
Practice Address - Phone:561-798-2425
Practice Address - Fax:561-798-6356
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6182207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054410800Medicaid
GA80541ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL054410800Medicaid