Healthcare Provider Details

I. General information

NPI: 1417988858
Provider Name (Legal Business Name): ALAN M DAVICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CULTURAL PARK BLVD
CAPE CORAL FL
33990-1217
US

IV. Provider business mailing address

3763 EVANS AVE
FORT MYERS FL
33901-9302
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-3222
  • Fax: 239-332-0287
Mailing address:
  • Phone: 239-275-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberME82303
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME82303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: