MEDICARE: VALERIE G. DAVIS, 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	207NS0135X	Procedural Dermatology Physician	ME51662	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K1455	OTHER	FL	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1477741916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALERIE G. DAVIS, M.D.

Provider Business Mailing Address
First Line	:	504 S ORANGE ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7319
Country	:	US
Telephone Number	:	386-423-2218
Fax Number	:	386-427-0980

Provider Business Practice Location Address
First Line	:	504 S ORANGE ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7319
Country	:	US
Telephone Number	:	386-423-2218
Fax Number	:	386-427-0980

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VALERIE G DAVIS
Credential	:	MD
Telephone Number	:	386-423-2218

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/10/2007

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