Provider Demographics
NPI:1700283926
Name:DAVIS, IFE (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:IFE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 49TH ST S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4387
Mailing Address - Country:US
Mailing Address - Phone:727-328-2623
Mailing Address - Fax:727-800-5007
Practice Address - Street 1:1834 49TH ST S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4387
Practice Address - Country:US
Practice Address - Phone:727-328-2623
Practice Address - Fax:727-800-5007
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL02391241744P3200X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No335E00000XSuppliersProsthetic/Orthotic Supplier