Healthcare Provider Details

I. General information

NPI: 1750514790
Provider Name (Legal Business Name): PHYSICIANS OF THE REFUGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14835 SE 85TH ST
OCKLAWAHA FL
32179-3556
US

IV. Provider business mailing address

14835 SE 85TH ST
OCKLAWAHA FL
32179-3556
US

V. Phone/Fax

Practice location:
  • Phone: 352-288-3333
  • Fax: 352-288-0760
Mailing address:
  • Phone: 352-288-3333
  • Fax: 352-288-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS DAVIES
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 352-288-3333