Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO4035 | FL |
N | 222Z00000X | Podiatrist | PO4035 | FL |
N | 213E00000X | Podiatrist | SC006042 | PA |
N | 222Z00000X | Podiatrist | SC006042 | PA |
Y | 213EP1101X | Primary Podiatric Medicine | 016.005441 | IL |
N | 213EP1101X | Primary Podiatric Medicine | 07001101A | IN |
NPI | 1063676575 |
---|---|
Provider Name | Kibibi Davison |
First Address | Tampa, FL 33634-2930 |
Second Address | Tampa, FL 33634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 11/03/2019 |