Provider Demographics
NPI:1750514790
Name:PHYSICIANS OF THE REFUGE
Entity type:Organization
Organization Name:PHYSICIANS OF THE REFUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-288-3333
Mailing Address - Street 1:14835 SE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:OCKLAWAHA
Mailing Address - State:FL
Mailing Address - Zip Code:32179-3556
Mailing Address - Country:US
Mailing Address - Phone:352-288-3333
Mailing Address - Fax:352-288-0760
Practice Address - Street 1:14835 SE 85TH ST
Practice Address - Street 2:
Practice Address - City:OCKLAWAHA
Practice Address - State:FL
Practice Address - Zip Code:32179-3556
Practice Address - Country:US
Practice Address - Phone:352-288-3333
Practice Address - Fax:352-288-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder