MEDICARE: WILLIAM JAVIER DAVILA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	01058007A	IN
2	207R00000X	Internal Medicine Physician	ME100955	FL

General Provider Information

NPI Number	:	1346214277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JAVIER DAVILA M.D.

Provider Business Mailing Address
First Line	:	115 BARTRAM OAKS WALK STE 104
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3247
Country	:	US
Telephone Number	:	904-450-7940
Fax Number	:	904-264-9750

Provider Business Practice Location Address
First Line	:	115 BARTRAM OAKS WALK STE 104
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3247
Country	:	US
Telephone Number	:	904-450-7940
Fax Number	:	49-450-7950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	05/26/2022

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