Healthcare Provider Details

I. General information

NPI: 1316904030
Provider Name (Legal Business Name): REZA DAVID SEIRAFI MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40124 HIGHWAY 27 STE 104
DAVENPORT FL
33837-5905
US

IV. Provider business mailing address

40124 HIGHWAY 27 STE 104
DAVENPORT FL
33837-5905
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-7626
  • Fax: 863-419-2421
Mailing address:
  • Phone: 863-421-7626
  • Fax: 863-419-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME173451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: