Healthcare Provider Details

I. General information

NPI: 1669489738
Provider Name (Legal Business Name): DOUGLAS J DAVIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOUGLAS J DAVIES

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 NE 55TH AVE
SILVER SPRINGS FL
34488-1721
US

IV. Provider business mailing address

3230 NE 55TH AVE
SILVER SPRINGS FL
34488-1721
US

V. Phone/Fax

Practice location:
  • Phone: 352-509-5720
  • Fax: 352-509-5890
Mailing address:
  • Phone: 352-509-5720
  • Fax: 352-509-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME43052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: