Healthcare Provider Details

I. General information

NPI: 1467316232
Provider Name (Legal Business Name): THOMAS E DAVIES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 ROBERT AVE
LEHIGH ACRES FL
33936-1619
US

IV. Provider business mailing address

107 ROBERT AVE
LEHIGH ACRES FL
33936-1619
US

V. Phone/Fax

Practice location:
  • Phone: 954-383-2321
  • Fax:
Mailing address:
  • Phone: 954-383-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: