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General NPI Number Information
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NPI Number | 1417988858
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Entity Type | Individual
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Provider Name | ALAN M DAVICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 1105 CULTURAL PARK BLVD
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City | CAPE CORAL
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State | FL
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Zip | 33990-1217
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Country | US
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Telephone | 239-275-3222
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Fax | 239-332-0287
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Provider Business Mailing Address
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Address Line | 3763 EVANS AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9302
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Country | US
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Telephone | 239-275-3222
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Fax |
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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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | ME82303
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME82303
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License Number State | FL
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