Healthcare Provider Details

I. General information

NPI: 1699986612
Provider Name (Legal Business Name): BARRY C DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BARRY C. DAVIS M.D.

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 FRIST BLVD SUITE 102 & 103
FORT PIERCE FL
34950-4838
US

IV. Provider business mailing address

2402 FRIST BLVD SUITE 102 & 103
FORT PIERCE FL
34950-4838
US

V. Phone/Fax

Practice location:
  • Phone: 772-465-4651
  • Fax: 772-465-4087
Mailing address:
  • Phone: 772-465-4651
  • Fax: 772-465-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME 115367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: