Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME53370 | FL |
N | 207XS0117X | Orthopaedic Spine Surgeon | ME53370 | FL |
NPI | 1043283948 |
---|---|
Provider Name | Mr. Clinton Bertrand Davis II |
First Address | St Petersburg, FL 33703-3802 |
Second Address | St Petersburg, FL 33703-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 16/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049362700 | (05) | FL |
D26987 | (02) | FL |
L9968 | MEDICARE (01) | FL |