Provider Demographics
NPI:1962674903
Name:MARIAN DAVIS DPM PA
Entity Type:Organization
Organization Name:MARIAN DAVIS DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAZE
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-479-5090
Mailing Address - Street 1:1190 NW 95TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2063
Mailing Address - Country:US
Mailing Address - Phone:305-835-8000
Mailing Address - Fax:305-835-0866
Practice Address - Street 1:1190 NW 95TH ST STE 401
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2067
Practice Address - Country:US
Practice Address - Phone:305-835-8000
Practice Address - Fax:305-835-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3333213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340694600Medicaid
FL65982OtherBCBSFL
FL65982OtherBCBSFL
FL6444180001Medicare NSC