MEDICARE: DR. EDWARD LEBRETTA DAVIS DO

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	2084N0400X	Neurology Physician	OS0004096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437151172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD LEBRETTA DAVIS DO

Provider Business Mailing Address
First Line	:	6100 WINKLER RD
Second Line	:	SUITE C
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8126
Country	:	US
Telephone Number	:	239-433-3500
Fax Number	:	239-433-0435

Provider Business Practice Location Address
First Line	:	6100 WINKLER RD
Second Line	:	SUITE C
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8126
Country	:	US
Telephone Number	:	239-433-3500
Fax Number	:	239-433-0435

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/04/2010

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