MEDICARE: RYAN DAVIS SR.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1780530691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DAVIS SR.

Provider Business Mailing Address
First Line	:	2392 EDGEWOOD AVE N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1725
Country	:	US
Telephone Number	:	904-781-7797
Fax Number	:	904-781-8685

Provider Business Practice Location Address
First Line	:	2392 EDGEWOOD AVE N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1725
Country	:	US
Telephone Number	:	904-781-7797
Fax Number	:	904-781-8685

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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