Healthcare Provider Details

I. General information

NPI: 1386609642
Provider Name (Legal Business Name): DIANE DAVIS DAVEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST ORLANDO VAMC, LABORATORY
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

6850 LAKE NONA BLVD COLLEGE OF MEDICINE, HEALTH SCIENCES CAMPUS, 4TH FLOOR
ORLANDO FL
32827-7408
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-1599
  • Fax: 407-599-1387
Mailing address:
  • Phone: 407-266-1100
  • Fax: 407-266-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25798
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number25798
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: