Healthcare Provider Details

I. General information

NPI: 1780835397
Provider Name (Legal Business Name): ELIZABETH DAVIS HOUSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE E DAVIS MD

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-4800
  • Fax: 321-843-2172
Mailing address:
  • Phone: 321-843-4800
  • Fax: 321-843-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberME109280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: