Healthcare Provider Details

I. General information

NPI: 1740229558
Provider Name (Legal Business Name): GEORGE R. DAVIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13311 N 56TH ST
TAMPA FL
33617-1161
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-899-2015
  • Fax: 813-980-2700
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS5749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: