Healthcare Provider Details

I. General information

NPI: 1578754875
Provider Name (Legal Business Name): JOSEPH BARTLETT DAVIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 SANDLAKE COMMONS BLVD MEDPLEX B, SUITE 2212A
ORLANDO FL
32819
US

IV. Provider business mailing address

9600 BLACKWELL RD STE 500
ROCKVILLE MD
20850-3783
US

V. Phone/Fax

Practice location:
  • Phone: 689-500-4016
  • Fax: 689-500-4032
Mailing address:
  • Phone:
  • Fax: 855-420-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number255869
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberOS19325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: