Healthcare Provider Details

I. General information

NPI: 1407900277
Provider Name (Legal Business Name): EDITH DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 95TH ST STE 401
MIAMI FL
33150
US

IV. Provider business mailing address

PO BOX 681578
MIAMI FL
33168-1578
US

V. Phone/Fax

Practice location:
  • Phone: 305-696-4400
  • Fax: 305-757-5522
Mailing address:
  • Phone: 305-696-4400
  • Fax: 305-696-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME53312
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME53312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: