Healthcare Provider Details

I. General information

NPI: 1487803474
Provider Name (Legal Business Name): LUKE E DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 W WATERS AVE
TAMPA FL
33614-2783
US

IV. Provider business mailing address

PO BOX 406153
ATLANTA GA
30384-1876
US

V. Phone/Fax

Practice location:
  • Phone: 813-931-2307
  • Fax: 813-931-8664
Mailing address:
  • Phone: 561-478-8770
  • Fax: 561-688-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS2820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: