Provider Demographics
NPI:1720527815
Name:ANTENOR, DAVIDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVIDSON
Middle Name:
Last Name:ANTENOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 S HIAWASSEE RD APT 1614
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1827
Mailing Address - Country:US
Mailing Address - Phone:321-444-5538
Mailing Address - Fax:
Practice Address - Street 1:453 N KIRKMAN RD
Practice Address - Street 2:STE 203
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-1109
Practice Address - Country:US
Practice Address - Phone:407-914-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE24126208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice