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General NPI Number Information
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NPI Number | 1457551657
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Entity Type | Individual
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Provider Name | STACY ANN MARIE DAVIS MD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 1334 VALENTINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3128
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Country | US
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Telephone | 321-676-1870
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Fax | 321-768-2172
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Provider Business Mailing Address
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Address Line | 95 BULLDOG BLVD SUITE 202
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City | MELBOURNE
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State | FL
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Zip | 32901-3332
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Country | US
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Telephone | 321-727-2990
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Fax | 321-724-0455
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME105521
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License Number State | FL
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