Healthcare Provider Details

I. General information

NPI: 1194702951
Provider Name (Legal Business Name): ALL FLORIDA ORTHOPAEDIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 4TH ST N
ST PETERSBURG FL
33703-3802
US

IV. Provider business mailing address

PO BOX 76359
ST PETERSBURG FL
33734-6359
US

V. Phone/Fax

Practice location:
  • Phone: 727-527-5272
  • Fax: 727-522-7412
Mailing address:
  • Phone: 727-527-5272
  • Fax: 727-369-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CLINTON DAVIS
Title or Position: MANAGING PHYSICIAN
Credential: M.D.
Phone: 727-527-5272