Provider Demographics
NPI:1871664326
Name:DAVANZO, DAWN M (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:DAVANZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-338-3300
Mailing Address - Fax:561-338-3303
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:SUITE 103A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-338-3300
Practice Address - Fax:561-338-3303
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00717167OtherRR MEDICARE
MS00126503Medicaid
FL000733600Medicaid
MS110001573Medicare PIN
MSH70240Medicare UPIN
MS00126503Medicaid