Provider Demographics
NPI:1669489738
Name:DAVIES, DOUGLAS J (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:J
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3230 NE 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34488-1721
Mailing Address - Country:US
Mailing Address - Phone:352-509-5720
Mailing Address - Fax:352-509-5890
Practice Address - Street 1:3230 NE 55TH AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488-1721
Practice Address - Country:US
Practice Address - Phone:352-509-5720
Practice Address - Fax:352-509-5890
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME430522084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036122400Medicaid
D57874Medicare UPIN