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General NPI Number Information
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NPI Number | 1053614305
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Entity Type | Organization
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Legal Business Name | VIJAYSELWYN DAVIS DHAS MD
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 301 HEALTH PARK BLVD STE 219
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5793
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Country | US
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Telephone | 904-824-9444
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Fax | 904-819-9594
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Provider Business Mailing Address
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Address Line | PO BOX 840262
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-0262
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Country | US
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Telephone | 904-824-9444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIHAYSELWYN DAVIS DHAS
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Credential | MD
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Telephone | 904-824-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME104834
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License Number State | FL
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