Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 045724 | FL |
NPI | 1245203702 |
---|---|
Provider Name | Mark R Davis |
First Address | Tampa, FL 33607-6383 |
Second Address | Tampa, FL 33607-6383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 28/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045587301 | (05) | FL |
D54119 | (02) | FL |