Healthcare Provider Details

I. General information

NPI: 1346214277
Provider Name (Legal Business Name): WILLIAM JAVIER DAVILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BARTRAM OAKS WALK STE 104
SAINT JOHNS FL
32259-3247
US

IV. Provider business mailing address

115 BARTRAM OAKS WALK STE 104
SAINT JOHNS FL
32259-3247
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-7940
  • Fax: 49-450-7950
Mailing address:
  • Phone: 904-450-7940
  • Fax: 904-264-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number01058007A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME100955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: