Healthcare Provider Details

I. General information

NPI: 1114165701
Provider Name (Legal Business Name): PAUL JOHN DAVIES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 S MIAMI AVE
MIAMI FL
33133-4205
US

IV. Provider business mailing address

10738 SW 88TH ST APT. K-7
MIAMI FL
33176-1468
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-0302
  • Fax: 305-854-0308
Mailing address:
  • Phone: 305-274-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN3225512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: