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General NPI Number Information
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NPI Number | 1063654531
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Entity Type | Individual
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Provider Name | SCOTT LEE DAVIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 807 CHILDRENS WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8426
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Country | US
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Telephone | 904-697-3600
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Fax | 904-697-3927
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Provider Business Mailing Address
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Address Line | 10140 CENTURION PKWY N
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0532
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Country | US
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Telephone | 904-697-4127
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Fax | 904-697-5102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | C10011705
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD457702
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME127880
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License Number State | FL
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