Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | D0066013 | MD |
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME129293 | FL |
NPI | 1083758536 |
---|---|
Provider Name | Charles William Davis II |
First Address | Dade City, FL 33523-7221 |
Second Address | Wesley Chapel, FL 33544-7366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2007 |
Last Update Date | 18/03/2019 |